Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and meta-analysis

World Journal of Emergency Surgery

Gianluca Bonitta¹  Alberto Aiolfi¹  Davide Ferrari¹  Francesco Toti¹  Emanuele Rausa¹  Stefano Siboni¹  Carlo Galdino Riva¹  Luigi Bonavina¹ 

[1] Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan;

关键词: Esophageal foreign body;    Flexible endoscopy;    Rigid endoscopy;    Iatrogenic esophageal perforation;    Foreign body impaction;   

DOI  :  10.1186/s13017-018-0203-4

来源: DOAJ

【 摘 要 】

Abstract Background Foreign body (FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy (FE) is recommended as the first-line therapeutic option because it can be performed under sedation, is cost-effective, and is well tolerated. Rigid endoscopy (RE) under general anesthesia is less used but may be advantageous in some circumstances. The aim of the study was to compare the efficacy and safety of FE and RE in esophageal FB removal. Methods PubMed, MEDLINE, Embase, and Cochrane databases were consulted matching the terms “Rigid endoscopy AND Flexible endoscopy AND foreign bod*”. Pooled effect measures were calculated using an inverse-variance weighted or Mantel-Haenszel in random effects meta-analysis. Heterogeneity was evaluated using I 2 index and Cochrane Q test. Results Five observational cohort studies, published between 1993 and 2015, matched the inclusion criteria. One thousand four hundred and two patients were included; FE was performed in 736 patients and RE in 666. Overall, 101 (7.2%) complications occurred. The most frequent complications were mucosal erosion (26.7%), mucosal edema (18.8%), and iatrogenic esophageal perforations (10.9%). Compared to FE, the estimated RE pooled success OR was 1.00 (95% CI 0.48–2.06; p = 1.00). The pooled OR of iatrogenic perforation, other complications, and overall complications were 2.87 (95% CI 0.96–8.61; p = 0.06), 1.09 (95% CI 0.38–3.18; p = 0.87), and 1.50 (95% CI 0.53–4.25; p = 0.44), respectively. There was no mortality. Conclusions FE and RE are equally safe and effective for the removal of esophageal FB. To provide a tailored or crossover approach, patients should be managed in multidisciplinary centers where expertise in RE is also available. Formal training and certification in RE should probably be re-evaluated.

【 授权许可】

Unknown