Management of ingested foreign bodies and food impactions

This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. In preparing this guideline, a search of the medical literature was performed by using PubMed. Studies or reports that described fewer than 10 patients were excluded from analysis if multiple series with more than 10 patients addressing the same issue were available. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time that the guidelines are drafted. Further controlled clinical studies may be needed to clarify aspects of this guideline. This guideline may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. The original guideline was published in 1995 and last updated in 2002. The recommendations are based on reviewed studies and are graded on the strength of the supporting evidence (Table 1).1 Guyatt G.H. Oxman A.D. Vist G.E. et al. Grade: an emerging consensus on rating quality of evidence and strength of recommendations. Bmj. 2008; 336: 924-926 Crossref PubMed Google Scholar The strength of individual recommendations is based both on the aggregate evidence quality and an assessment of the anticipated benefits and harms. Weaker recommendations are indicated by phrases such as “we suggest,” whereas stronger recommendations are typically stated as “we recommend.” TABLE 1GRADE system for rating the quality of evidence for guidelines Quality of evidence Definition Symbol High quality Further research is very unlikely to change our confidence in the estimate of effect ⊕⊕⊕⊕ Moderate quality Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate ⊕⊕⊕○ Low quality Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate ⊕⊕○○ Very low quality Any estimate of effect is very uncertain ⊕○○○ Adapted from Guyatt et al. 1 Guyatt G.H. Oxman A.D. Vist G.E. et al. Grade: an emerging consensus on rating quality of evidence and strength of recommendations. Bmj. 2008; 336: 924-926 Crossref PubMed Google Scholar Open table in a new tab Adapted from Guyatt et al. 1 Guyatt G.H. Oxman A.D. Vist G.E. et al. Grade: an emerging consensus on rating quality of evidence and strength of recommendations. Bmj. 2008; 336: 924-926 Crossref PubMed Google Scholar Illicit drug packet ingestion and the ASGE clinical guideline on removal of foreign bodiesGastrointestinal EndoscopyVol. 94Issue 1PreviewRecently at the New Jersey Poison Center, we consulted on a patient who swallowed packets of heroin to evade law enforcement and was admitted to the hospital for whole bowel irrigation with polyethylene glycol solution. After 24 hours, the packets were still in the stomach, and disagreement arose within the treatment team based on “Management of ingested foreign bodies and food impactions” from the American Society for Gastrointestinal Endoscopy,1 which recommends against endoscopic packet retrieval and for surgical intervention if packets fail to progress. Full-Text PDF