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Background: The epidemiology of esophageal foreign-body impaction (EFBI) is poorly described, and the impact of the increasing prevalence of eosinophilic esophagitis (EoE) on this is unknown., Objective: To assess the characteristics of patients with EFBI, to determine whether EFBI cases increased in proportion to EoE cases, and to identify predictors of EFBI., Design: Retrospective study., Setting: Tertiary care center., Patients: Cases of EFBI from 2002 to 2009 were identified by querying billing, clinical, and endoscopy databases for the International Classification of Diseases, 9th Revision, Clinical Modification code 935.1, "foreign body in the esophagus." Charts were reviewed to confirm EFBI and to extract pertinent data. Cases of EoE were defined per guidelines., Results: Of 548 patients with EFBI (59% male, 68% white, bimodal age distribution), 482 (88%) required a procedure, 347 (63%) had food impactions, and 51 (9%) had EoE. EFBIs increased over the study time frame, and the number of EGDs performed for EFBI nearly quadrupled. Increasing diagnosis of EoE did not fully account for this trend, but only 27% of patients who underwent EGD had esophageal biopsies. Of patients who underwent biopsy, 46% had EoE. EoE was the strongest predictor of multiple EFBIs (odds ratio 3.5; 95% CI, 1.8-7.0)., Limitations: Retrospective, single-center study., Conclusions: The number of EGDs performed for EFBI has increased dramatically at our center, but increasing EoE prevalence only partially explains this trend. Because only a minority of EFBI patients underwent biopsies and because nearly half of those who did undergo biopsy had EoE, the incidence of EoE may be substantially underestimated. Physician education is needed to increase the proportion of subjects with EFBI who undergo biopsies., (Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.)

Background: Previous reports of foreign-body ingestions focused primarily on accidental ingestions., Objective: To describe the characteristics and management of foreign-body ingestions, with predominantly intentional ingestion, in a lower socioeconomic status population., Design: A retrospective case series., Setting: An urban county hospital., Patients: Patients >/=17 years old, with foreign-body ingestions between 2000 and 2006., Main Outcome Measurements: Characteristics of ingestion cases, endoscopic extraction, need for surgery, and complications., Results: Among 262 cases, 92% were intentional, 85% involved psychiatric patients, and 84% occurred in patients with prior ingestions. The time from ingestion to presentation was >48 hours in 168 cases (64%). The overall success rate for endoscopic extraction was 90% (165/183 cases). Surgery was performed in 30 cases (11%) and was more common for objects beyond the pylorus versus objects above the pylorus (16/43 [37%] vs 10/151 [7%], respectively) and in cases with a greater delay from ingestion to presentation (25/168 [15%] if >48 hours vs 4/77 [5%] if 48 hours vs 14/165 [8%] if

Background: Reports on endoscopic management of ingested foreign bodies of the upper-GI tract in China are scarce., Objective: To report our experience and outcome in the management of ingestion of foreign bodies in Chinese patients., Setting and Patients: Between January 1980 and January 2005, a total of 1088 patients (685 men and 403 women; age range, 1 day to 96 years old) with suspected foreign bodies were admitted to our endoscopy center., Interventions: All patients underwent endoscopic procedure after admission., Main Outcome Measurements: Demographic and endoscopic data, including age, sex, and referral sources of patients, types, number and location of foreign bodies, associated upper-GI diseases, endoscopic methods, and accessory devices for removal of foreign bodies were collected and analyzed., Results: A total of 1090 foreign bodies were found in 988 (90.8%) patients. The types of foreign bodies varied greatly: mainly food boluses, coins, fish bones, dental prostheses, or chicken bones. The foreign bodies were located in the pharynx (n = 12), the esophagus (n = 577), the stomach (n = 441), the duodenum (n = 50), and the surgical anastomosis (n = 10). The associated GI diseases (n = 88) included esophageal carcinoma (33.0%), stricture (23.9%), diverticulum (15.9%), postgastrectomy (11.4%), hiatal hernia (10.2%), and achalasia (5.7%). A rat-tooth forceps and a snare were the most frequently used accessory devices. The success rate for foreign-body removal was 94.1% (930/988)., Conclusions: Ingestion of foreign bodies is a common clinic problem in China. Endoscopy procedures are frequently performed, and a high proportion of patients with foreign bodies require endoscopic intervention.

Background: Foreign body ingestions are common, especially in pediatric, edentulous, psychiatric, and incarcerated populations. For the 20% of foreign bodies that do not pass spontaneously through the gastrointestinal tract, removal using modern, flexible endoscopes has become routine., Methods: We describe the successful endoscopic removal of a ring-type or "closed loop" foreign body by means of a novel technique. Utilizing a nasogastric tube inserted alongside the endoscope, a guidewire inserted through the tube is directed through the ring with a "rat-tooth" grasping forceps passed through the accessory channel of the endoscope. The wire is snared and pulled up through the endoscope creating a "U," with both ends of the wire outside of the patient. The nasogastric tube, endoscope, and foreign body may then be removed safely., Results: The technique was easy to perform and the foreign body was removed without complication., Conclusions: Using the U-wire technique, ring-type foreign bodies may be readily and safely removed.