Foreign bodies in the gastrointestinal tract in children: algorithm of management and choice of instruments for endoscopic removal

BACKGROUND: A foreign body (FB) in the gastrointestinal tract (GIT) may require either emergent removal or careful observation till its natural coming out. The effectiveness of endoscopic procedure (EP) in pediatrics depends on adequate medical knowledge and medical equipment. Not uncommon, endoscopists and surgeons from adult medical centers remove FB in children. Over the past decades, EP in the GIT has become the safest and most successful technique for FB diagnosis and removal.

Up to now, there is no algorithm for managing and removing FB in children, or it does not always meet needs in clinical practice. To assess and choose the most optimal endoscopic equipment and instrumental accessories regarding child’s age, FB type and its harmful effects is still an important issue.

AIM: To improve a management algorithm and selection of optimal equipment to ensure timely diagnostics and successful endoscopic removal of FBs from GIT in children.

METHODS: A retrospective three-center analysis of children’s medical histories with suspected FBs in GIT from 2017 to 2020. The following parameters were analysed: clinical, X-ray and endoscopic diagnostic techniques depending on patient's age, FB location, its type and radiopacity, time before its removal, as well as type and effectiveness of endoscopic instrument, duration of endoscopic procedure, its effectiveness and complications, if any.

RESULTS: 1173 children were taken in the study (boys n=676, girls n=497,) average age 3.5±3.3, (0–17 y.o.). FB diagnosis was confirmed in 1008 (100%) patients; endoscopy was performed in 756 (75%) cases; endoscopic removal — in 751 out of 756 cases. Surgeries were made to three children with giant trichobezoars and to two children with magnet objects which were complicated by perforation in one case and by intestinal obstruction in the other one. The performed retrospective analysis of children’s medical histories with suspected GIT FBs allowed to modify the algorithm of multidisciplinary approach to the management and endoscopic removal of swallowed objects. Examination by an ENT specialist and a pediatric surgeon was mandatory at the reception department. The pediatric surgeon formulated indications for X-ray examination in two projections. The confirmed fact of FB swallowing and X-ray findings could be indicators for CT scanning. After FB presence has been confirmed, the patient is jointly consulted by a pediatric surgeon, anesthesiologist and endoscopist so as to determine indications and time interval for removing a swallowed object endoscopically.

Endoscopic instruments — net, rat tooth, forceps, loop and basket — turned out to be the most universal ones for removing four FB types, with the best average time of the procedure.

There were no complications related to FB endoscopic removal.

CONCLUSION: The proposed algorithm modification in child’s management and removal of GIT FB, the optimal choice of endoscopic equipment and manipulation accessories depending on patient’s age, FB location, type and its harm are key points to its successful and effective FB removal in children.