A national retrospective analysis of the management of patients presenting as an emergency with foreign body in the oesophagus

Introduction

Emergency admission with foreign body in the oesophagus (FBO) commonly requires endoscopic removal. Oesophageal food bolus obstruction is often due to eosinophilic oesophagitis (EoE). Patients with food bolus obstruction should undergo endoscopy and multilevel oesophageal biopsies to exclude EoE. This national retrospective study examined the management including endoscopy and follow-up of patients presenting as an emergency with FBO.

Methods

The Hospital Episode Statistics database was used to identify patients over 18 with FBO presenting as emergencies in England using the ICD-10 code T18.1 between 2008 and 2019. Logistic regression analysis assessed factors associated with undergoing endoscopy and biopsy.

Results

10,417 patients were identified: 71% male; 82% white ethnicity; and 52% were admitted under Ear, Nose & Throat (ENT). 74.7% underwent endoscopy (94% within a week of admission) but only 18% had biopsies taken within 6 months of admission. 1.6% underwent endoscopic dilation for FBO, with 0.5% coded with a related perforation. 70% of ENT patients underwent endoscopy but only 11.9% biopsy to exclude EOE, compared with 83% of patient admitted under General Medicine undergoing endoscopy and 29.5% biopsy. Endoscopy and biopsy was associated with: older age (61–70 OR 1.43 (95% CI 1.26–1.61), males (females 0.67(0.62–0.71)), the least deprived (1.24 (1.13–1.38)), later diagnosis year (2019 1.42 (1.21–1.66), and admission under General Medicine (2.68(2.48–2.88) or Gastroenterology (3.03(2.61–3.51)) but not with NHS trust FBO volume. 32% received outpatient follow-up within 12 months of their FBO admission: 30% of patients admitted under General Medicine were referred to gastroenterology for follow-up but only 12% of those admitted under ENT. In recent data from Scotland (Ntuli et al. 2020), 26% of patients with food bolus obstruction had EoE. This suggests that in the present study cohort approximately 1300 patients missed an opportunity to be diagnosed with EoE, as oesophageal biopsies were not taken at endoscopy for FBO.

Conclusions

75% of patients presenting with FBO undergo endoscopy but only 18% had biopsies taken to exclude this common presentation of EoE. Pathways for the management of food bolus obstruction require re-design and unless the airway is impaired, this condition should be managed under General Medicine.