A New Trend in the Management of Esophageal Foreign Bodies: Transnasal Esophagoscopy

Abstract

Objectives:

(1) Retrospectively review esophageal foreign body (EFB) management. (2) Analyze the outcome of patients with EFB managed by either transnasal esophagoscopy (TNE) or rigid esophagoscopy. (3) Review the value of neck lateral view x-ray.

Methods:

We retrospectively reviewed the cases suspicious for EFB managed between January 2007 and December 2013. In each case, neck lateral view was used for initial screening and the cases suspected to have EFB underwent esophagoscopy, which was rigid before July 2010, and TNE after July 2010.

Results:

From January 2007 to June 2010, 43 patients received rigid esophagoscopy and 31(72.1%) of them were positive for EFB. From July 2010 to December 2013, 302 patients underwent TNE. EFB was noted in only 52 patients and in 36 (69.2%) patients, the EFB could be removed by TNE, while in the other 16 patients with large, or sharp EFB, or possibly perforated esophagus, the EFB could only be removed by rigid esophagoscopy. In the 302 patients that underwent TNE, the sensitivity and specificity of true EFB by neck lateral view x-ray was 59% and 83%, respectively. There is no major complication of mediastinitis or esophageal perforation in both groups.

Conclusions:

The introduction of TNE changes the diagnosis and management for EFB. TNE is a quick and safe office procedure under local anesthesia. Neck lateral view X-ray should not be a routine examination any more. TNE could replace neck lateral view X-ray to be the first screening procedure and also a useful treatment for patients with EFB.