Emergency care of esophageal foreign body impactions: timing, treatment modalities, and resource utilization

Authors

  • S. D. Crockett,

    Corresponding author
    1. Center for Esophageal Diseases and Swallowing
    2. Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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  • S. L. W. Sperry,

    1. Center for Esophageal Diseases and Swallowing
    2. Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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  • C. Brock Miller,

    1. Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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  • N. J. Shaheen,

    1. Center for Esophageal Diseases and Swallowing
    2. Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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  • E. S. Dellon

    1. Center for Esophageal Diseases and Swallowing
    2. Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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  • Author contributions: (all authors approved final submission)

  • Crockett: Study design; data acquisition; chart abstraction; data analysis/interpretation, manuscript drafting/revision.

  • Sperry: Chart abstraction; data analysis/interpretation; manuscript revision.

  • Miller: Chart abstraction; manuscript revision.

  • Shaheen: Study concept; data interpretation; manuscript revision.

  • Dellon: Study concept and design; data analysis/interpretation; manuscript revision.

  • Conflict of interest: Dr Shaheen has served as a consultant to Astra Zeneca and CSA Medical, and has received research support from Astra Zeneca, Takeda, Procter & Gamble, BARRX Medical, CSA Medical, and Oncoscope. Dr Dellon has received research support from Astra Zeneca. Other coauthors have no competing interests to declare.

Dr Seth D. Crockett, MD, MPH, UNC Division of Gastroenterology, CB#7080, Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC 27599, USA. Email: sethc@med.unc.edu

SUMMARY

Esophageal foreign body impaction (EFBI) often requires urgent evaluation and treatment, but characteristics of emergency department (ED) care such as timing of presentation and therapeutic procedures and costs of care are unknown. We aimed to study health-care utilization for patients with EFBI presenting to the ED. Cases of EFBI from 2002 to 2009 were identified by querying three different databases from the University of North Carolina Hospitals for all records with ICD-9 CM code 935.1: ‘foreign body in the esophagus.’ Charts were reviewed to confirm EFBI and extract pertinent data related to the ED visit, including time of presentation, length of ED stay, medications administered, type of procedure performed, characteristics of procedures, and time to therapeutic procedure. Hospital charges for EFBI encounters and consult fees were determined from the Physicians' Fee Reference 2010, and were compiled to estimate costs. Of the 548 cases of EFBI identified, 351 subjects (64%) presented to the ED. A total of 118 (34%) patients received a medication to treat EFBI, which was only effective in 8% of those patients. Two hundred ninety (83%) subjects underwent a procedure including esophagogastroduodenoscopy (EGD) (n=206) or ear, nose, and throat surgery (ENT)-performed laryngoscopy/esophagoscopy (n=138). Admission to the hospital occurred in 162 (46%) of cases. There was no relationship between ED arrival time and time-to-procedure or total time in ED. There was also no significant relationship between delivery of ED medications and likelihood of undergoing a procedure, or between ED arrival time and delivery of medications. The charges associated with a typical EFBI episode ranged from $2284–$6218. In conclusion, the majority of patients with EFBI at our institution presented to the ED. Medical management was largely ineffective. A therapeutic procedure was required to clear the EFBI in most patients. Time of ED arrival made no difference in time-to-procedure, indicating that gastroenterology and ENT specialists recognize the urgency of treating EFBI regardless of time of day.

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