title: Risk factors for complications associated with upper gastrointestinal foreign bodies.
abstract: OBJECTIVE
  To investigate predictive risk factors associated with complications in the endoscopic removal of foreign bodies from the upper gastrointestinal tract.
  
  
  METHODS
  We retrospectively reviewed the medical records of 194 patients with a diagnosis of foreign body impaction in the upper gastrointestinal tract, confirmed by endoscopy, at two university hospital in South Korea. Patient demographic data, including age, gender, intention to ingestion, symptoms at admission, and comorbidities, were collected. Clinical features of the foreign bodies, such as type, size, sharpness of edges, number, and location, were analyzed. Endoscopic data those were analyzed included duration of foreign body impaction, duration of endoscopic performance, endoscopic device, days of hospitalization, complication rate, 30-d mortality rate, and the number of operations related to foreign body removal.
  
  
  RESULTS
  The types of upper gastrointestinal foreign bodies included fish bones, drugs, shells, meat, metal, and animal bones. The locations of impacted foreign bodies were the upper esophagus (57.2%), mid esophagus (28.4%), stomach (10.8%), and lower esophagus (3.6%). The median size of the foreign bodies was 26.2 ± 16.7 mm. Among 194 patients, endoscopic removal was achieved in 189, and complications developed in 51 patients (26.9%). Significant complications associated with foreign body impaction and removal included deep lacerations with minor bleeding (n = 31, 16%), ulcer (n = 11, 5.7%), perforation (n = 3, 1.5%), and abscess (n = 1, 0.5%). Four patients underwent operations because of incomplete endoscopic foreign body extraction. In multivariate analyses, risk factors for endoscopic complications and failure were sharpness (HR = 2.48, 95%CI: 1.07-5.72; P = 0.034) and a greater than 12-h duration of impaction (HR = 2.42, 95%CI: 1.12-5.25, P = 0.025).
  
  
  CONCLUSIONS
  In cases of longer than 12 h since foreign body ingestion or sharp-pointed objects, rapid endoscopic intervention should be provided in patients with ingested foreign bodies.
authors.affiliation: Kyong Hee Hong, Jae Hak Kim, Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Graduate School, Goyang 410-773, South Korea.
authors.forename: Kyong Hee
authors.initials: KH
authors.lastname: Hong
authors.affiliation: Kyong Hee Hong, Jae Hak Kim, Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Graduate School, Goyang 410-773, South Korea.
authors.forename: Yoon Jae
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Kyong Hee Hong, Jae Hak Kim, Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Graduate School, Goyang 410-773, South Korea.
authors.forename: Jae Hak
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Kyong Hee Hong, Jae Hak Kim, Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Graduate School, Goyang 410-773, South Korea.
authors.forename: Song Wook
authors.initials: SW
authors.lastname: Chun
authors.affiliation: Kyong Hee Hong, Jae Hak Kim, Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Graduate School, Goyang 410-773, South Korea.
authors.forename: Hee Man
authors.initials: HM
authors.lastname: Kim
authors.affiliation: Kyong Hee Hong, Jae Hak Kim, Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Graduate School, Goyang 410-773, South Korea.
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D004945:Esophagoscopy / Q000009:adverse effects* / Q000401:mortality; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005260:Female; D005547:Foreign Bodies / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects* / Q000401:mortality; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complication; Emergency department; Endoscopy; Foreign body; Upper gastrointestinal tract