Esophageal foreign bodies and eosinophilic esophagitis--the need for esophageal mucosal biopsy: a 12-year survey across pediatric subspecialties.
BACKGROUND
Esophageal foreign body impaction (EFBI) is a common problem requiring urgent endoscopy. EFBI may be the first sign of underlying esophageal pathology, yet mucosal biopsies are rarely performed.


METHODS
We report a retrospective analysis of 572 children requiring removal of an EFBI over a 12-year period by pediatric otolaryngologists (ENT), surgeons (PS), and gastroenterologists (PGI). The method of removal [direct laryngoscopy (DL), rigid endoscopy (RE), flexible endoscopy (FE)], type of foreign body (inanimate or food), whether mucosal biopsies were performed, and histologic findings of biopsy samples were recorded for each patient.


RESULTS
Foreign body removal was most commonly performed by PGI (298 [52 %]); the remaining were equally distributed between ENT (136 [24 %]) and PS (138 [24 %]). The method of foreign body removal used by ENT was RE (89 %), DL (8 %), and FE (3 %). Pediatric surgery preferred FE (62 %), followed by RE (27 %) and DL (11 %). Pediatric gastroenterology used FE exclusively. Esophageal biopsies were never performed by ENT or PS; PGI performed esophageal biopsies more commonly in children with meat bolus impactions (50 %) than in children with inanimate foreign bodies (12 %). Mucosal pathology was more common in children with meat bolus impaction (100 %) than in children with inanimate foreign bodies (45 %).


CONCLUSIONS
Esophageal mucosal biopsy should be considered for all children with EFBI not attributed to stricture, particularly those with meat bolus impaction.
Division of Pediatric Gastroenterology, University of Mississippi Health Center, 2500 North State Street, Jackson, MS 39216, USA.
Paul
P
Williams
Samuel
S
Jameson
Phyllis
P
Bishop
David
D
Sawaya
Michael
M
Nowicki
D001706:Biopsy / Q000379:methods; D002675:Child, Preschool; D057765:Eosinophilic Esophagitis / Q000473:pathology*; D004945:Esophagoscopy / Q000706:statistics & numerical data*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005547:Foreign Bodies / Q000601:surgery*; D005762:Gastroenterology / Q000706:statistics & numerical data; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D007828:Laryngoscopy / Q000706:statistics & numerical data*; D008297:Male; D010036:Otolaryngology / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies