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Endoscopy is Noninvasive Alternative to Surgery for Foreign Object Removal From the Gastrointestinal Tract

Tuesday, August 21, 2007 General News J E 4
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OAK BROOK, Ill., Aug. 20 Foreign objectingestion is more common than people think, and while the majority of objectsswallowed occur among children, it also happens to adults, primarily thosewith psychiatric disorders and the mentally handicapped. The recent recall oftoys containing small magnets that can come loose and be swallowed by youngchildren highlights the risk of serious injury when foreign objects areingested. The majority of foreign objects, 80 percent, that reach thegastrointestinal tract will pass naturally and not require treatment. Ten to20 percent, however, will require nonoperative intervention, while one percentor less will require surgery. Endoscopy is safe and effective in treatingpatients who have swallowed a foreign object that will not pass naturally.

"Seeking medical attention immediately after a person has swallowed aforeign object is vital in preventing complications and reducing injury.Symptoms include choking, chest pain, abdominal pain, respiratory symptoms,and vomiting," said Marsha Kay, MD, spokesperson for the American Society forGastrointestinal Endoscopy and pediatric gastroenterologist at the ClevelandClinic. "Once a physician has made the diagnosis, they will decide if theobject can pass through the body without intervention or if removal isnecessary immediately. When intervention is required, endoscopy is anoninvasive and effective method for removal of the object."

Serious complications and even death can occur when a foreign object isswallowed and not treated immediately. The recent toy recall highlights thedangers caused when small magnets are swallowed by children. If more than onemagnet is swallowed, they can attract each other and cause intestinalperforation, fistulas (holes) or blockage, which can be fatal. If the magnetsare in the esophagus, stomach or duodenum (just below the stomach), retrievalis done endoscopically through the throat. Magnets in the lower part of thesmall intestine or in the large intestine must be removed surgically if theydo not pass safely.

In 2005, nearly 111,000 ingestions of foreign objects by people 19 andunder were reported to the American Poison Control Centers. Both children andadults may accidentally ingest foreign objects, including coins (the mostcommon object swallowed by children), batteries, toys, pins, and food such aspieces of meat or bones (chicken or fish). These items may get stuck or lodgedat various locations in the gastrointestinal tract and all require removal.Other objects require removal even if they are not stuck due to theirpotential to cause injury. Examples include batteries lodged in the esophagus,and sharp or large foreign objects of any kind.

Some foreign objects do not require removal and may pass on their ownunder physician supervision. Because recommendations for therapy vary based onthe patient's age, size, type of object, its location in the body andsymptoms, individuals should contact their physician or gastroenterologist inevery case of foreign object ingestion. A coin in the stomach should passharmlessly in four to six days, but if it has not passed into the stomachwithin 12 to 24 hours and stays in the esophagus, endoscopy should be used toremove it. If a patient cannot swallow or is experiencing acute respiratorysymptoms, the coin should be removed immediately.

The presence and location of a foreign object may be determined by X-ray.Sometimes the foreign object is not visible by X-ray and requires anendoscopic procedure for diagnosis. In addition to diagnostic purposes,endoscopy is used as a noninvasive alternative to surgery for removal offoreign objects. Removal may be done by both upper endoscopy and colonoscopy,depending on their location.

Battery ingestion is also common among young children in the U.S. and inindividuals with psychiatric disorders, and often does not present symptoms.It is especially dange
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