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Shea Gallagher*, Cameron Ghafil, Yutung Wu, Ed Compton, Shivani Sundaram, Philip T. Paulson, James L. Buxbaum, Morgan Schellenberg, Matthew Martin, Kenji Inaba, Kazuhide Matsushima
University of Southern California, Los Angeles, CA

There are scarce data to standardize the management of foreign body ingestion (FBI) in the adult population. Therefore, practice patterns vary widely, including the use of serial imaging and triggers for surgical intervention. This study aims to identify risk factors for complications and the need for operative intervention for FBI.

This is an observational cohort study at a single institution with high FBI volume. Adult patients, aged ≥18 years, with FBI from 2015-2021 were included. Demographics, clinical and foreign body (FB) data (e.g., sharpness, length), and outcomes were analyzed. Multivariate logistic regression was utilized to identify FB characteristics associated with the need for operative interventions.

A total of 302 encounters for the management of FBI were included. The median age was 29, and the majority were male (n=250, 83%). The mean number of hospital admissions for FBI per patient was 2.8. Ingested FBs were classified as sharp/pointed (n=202, 67%), dull (n=116, 38%), magnetic (n=25, 8%), or corrosive/battery (n=14, 5%). Eighteen percent of patients ingested multiple types of FBs. Two or more FBs were ingested by 61% of patients, and the mean number of FBs ingested per patient was 3.

Forty percent of encounters underwent endoscopic interventions, including esophagogastroduodenoscopy (EGD) (n=107, 35%), and colonoscopy (n=14, 5%) for retrieval of FBs. Twelve (4%) patients underwent an operative intervention secondary to perforation (n=10) or failure to progress (n=2). Patients with perforation or failure to progress had longer median FB lengths compared to patients without these complications (11.5 cm vs 3.0 cm, p<0.001). Fifty-nine percent (n=178) of patients underwent conservative management with neither endoscopy nor surgery.

On multivariate regression, length of FB was significantly associated with perforation or failure to progress necessitating operative interventions (OR 1.67 for each centimeter increment, 95% CI: 1.33-2.01, p<0.001). None of the patients with FB length <6 cm developed complications from FBI. Neither sharp/pointed FBs (OR 0.21, 95% CI: 0.04-1.10, p=0.07), nor the number of FBs (OR 1.23, 95% CI: 0.77-1.95, p=0.39) were predictive of the need for operative interventions.

The length of FB ingested was the primary predictive factor for complications necessitating operative intervention. Early endoscopic removal of long FBs should be considered when feasible. Our results suggest that for patients with FB length <6 cm can be discharged prior to complete passage of FBs, and that sharpness should not be a key consideration in management.

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