This Guideline is an official statement of the European Society of Gastrointestinal
Endoscopy (ESGE). It addresses the removal of foreign bodies in the upper gastrointestinal
tract in adults. Recommendations Nonendoscopic measures 1 ESGE recommends diagnostic
evaluation based on the patient's history and symptoms. ESGE recommends a physical
examination focused on the patient's general condition and to assess signs of any
complications (strong recommendation, low quality evidence). 2 ESGE does not recommend
radiological evaluation for patients with nonbony food bolus impaction without complications.
We recommend plain radiography to assess the presence, location, size, configuration,
and number of ingested foreign bodies if ingestion of radiopaque objects is suspected
or type of object is unknown (strong recommendation, low quality evidence). 3 ESGE
recommends computed tomography (CT) scan in all patients with suspected perforation
or other complication that may require surgery (strong recommendation, low quality
evidence). 4 ESGE does not recommend barium swallow, because of the risk of aspiration
and worsening of the endoscopic visualization (strong recommendation, low quality
evidence). 5 ESGE recommends clinical observation without the need for endoscopic
removal for management of asymptomatic patients with ingestion of blunt and small
objects (except batteries and magnets). If feasible, outpatient management is appropriate
(strong recommendation, low quality evidence). 6 ESGE recommends close observation
in asymptomatic individuals who have concealed packets of drugs by swallowing ("body
packing"). We recommend against endoscopic retrieval. We recommend surgical referral
in cases of suspected packet rupture, failure of packets to progress, or intestinal
obstruction (strong recommendation, low quality evidence). Endoscopic measures 7 ESGE
recommends emergent (preferably within 2 hours, but at the latest within 6 hours)
therapeutic esophagogastroduodenoscopy for foreign bodies inducing complete esophageal
obstruction, and for sharp-pointed objects or batteries in the esophagus. We recommend
urgent (within 24 hours) therapeutic esophagogastroduodenoscopy for other esophageal
foreign bodies without complete obstruction (strong recommendation, low quality evidence).
8 ESGE suggests treatment of food bolus impaction in the esophagus by gently pushing
the bolus into the stomach. If this procedure is not successful, retrieval should
be considered (weak recommendation, low quality evidence). The effectiveness of medical
treatment of esophageal food bolus impaction is debated. It is therefore recommended,
that medical treatment should not delay endoscopy (strong recommendation, low quality
evidence). 9 In cases of food bolus impaction, ESGE recommends a diagnostic work-up
for potential underlying disease, including histological evaluation, in addition to
therapeutic endoscopy (strong recommendation, low quality evidence). 10 ESGE recommends
urgent (within 24 hours) therapeutic esophagogastroduodenoscopy for foreign bodies
in the stomach such as sharp-pointed objects, magnets, batteries and large/long objects.
We suggest nonurgent (within 72 hours) therapeutic esophagogastroduodenoscopy for
medium-sized blunt foreign bodies in the stomach (strong recommendation, low quality
evidence). 11 ESGE recommends the use of a protective device in order to avoid esophagogastric/pharyngeal
damage and aspiration during endoscopic extraction of sharp-pointed foreign bodies.
Endotracheal intubation should be considered in the case of high risk of aspiration
(strong recommendation, low quality evidence). 12 ESGE suggests the use of suitable
extraction devices according to the type and location of the ingested foreign body
(weak recommendation, low quality evidence). 13 After successful and uncomplicated
endoscopic removal of ingested foreign bodies, ESGE suggests that the patient may
be discharged. If foreign bodies are not or cannot be removed, a case-by-case approach
depending on the size and type of the foreign body is suggested (weak recommendation,
low quality evidence).