Small but high risk: a 10-year single-hospital study on sharp gastrointestinal foreign bodies—the case of the jujube pit

Background: Guidelines from Europe and the United States concur that sharp foreign bodies (FBs) whose length exceeds 2.5 cm seldom traverse the pylorus and are associated with serious complications. To determine whether jujube pits conform to this rule, we investigated the clinical course of patients with jujube pit impaction, characterized the patient populations at greatest risk, and compared the diagnostic performance of barium esophagography (BE) and multidetector computed tomography (MDCT). Methods: A single-center retrospective study was conducted on cases of jujube pit impaction treated from January 2014 to June 2024. Demographic, clinical, radiological, and surgical data were collected and analyzed. The ingestion-to-diagnosis interval was collected in patients diagnosed via MDCT. The impaction sites of the gastrointestinal (GI) tract and diagnosis date of the event were recorded for both BE and MDCT. The length and width of the jujube pit were measured on MDCT imaging, and interobserver agreement was assessed via the intraclass correlation coefficient (ICC). The performance of BE and MDCT in diagnosing subphrenic impaction and perforation was compared, with the surgical findings serving as the reference. Results: Of the 1,680 patients diagnosed via BE, 599 (35.7%) required endoscopic extraction, while of the 184 cases diagnosed by MDCT, 32 (17.4%) required this procedure. Admission for this condition clustered in the May-July period-peak season for jujube-filled zongzi (BE: 853/1,680, 50.8%; MDCT: 80/184, 43.5%). BE showed most pits lodged in the cervical (n=644) or upper thoracic esophagus (n=934). Perforations were confirmed intraoperatively in 27 of 32 patients-almost all subphrenic-with pits length shorter than 25 mm responsible for 18 of these cases. The length of jujube pits ranged from 1.4 to 3.5 cm (ICC =0.990), and the impaction site and length were not correlated. Contrary to guideline assertions, pits <25 mm accounted for 66.7% (18/27) of perforations, with the most being located in the small intestine. Conclusions: Jujube pit impaction peaks around the Dragon Boat Festival, and MDCT outperforms BE in detecting subphrenic pits and perforations. The impaction site and perforation risk are independent of jujube length, but shorter pits (<25 mm) are more likely to perforate the small intestine, as these double-pointed, broad fragments flip and wedge between mucosal folds. Given that no pit size is "safe" and public awareness remains low, primary prevention through dietary education is imperative.