Affiliation:
1. Endoscopy Center and Endoscopy Research Institute Zhongshan Hospital Fudan University Shanghai China
2. Department of Gastroenterology Tianjin First Central Hospital Tianjin China
3. Department of Gastroenterology Tianjin Medical University General Hospital Tianjin China
4. Department of Gastroenterology Tianjin Fifth Central Hospital Tianjin China
5. Shanghai Collaborative Innovation Center of Endoscopy Shanghai China
Abstract
AbstractBackground and AimsDuodenal perforation caused by foreign bodies (FBs) is very rare but is an urgent emergency that traditionally requires surgical intervention. Several case reports have reported the successful endoscopic removal of duodenal perforating FBs. Here we aimed to evaluate the safety and efficacy of endoscopic management of duodenal perforating FBs in adults.MethodsBetween October 2004 and October 2022, 12,851 patients with endoscopically diagnosed gastrointestinal FBs from four tertiary hospitals in China were retrospectively reviewed. Patients were enrolled if they were endoscopically and/or radiographically diagnosed with duodenal perforating FBs.ResultsThe incidence of duodenal total FBs and perforating FBs was 1.9% and 0.3%, respectively. Thirty‐four patients were enrolled. Endoscopic removal was achieved in 25 patients (73.5%), and nine patients (26.5%) received surgery. For the endoscopic group, most perforating FBs were located in the duodenal bulb (36.0%) and descending part (28.0%). The adverse events included 3 mucosal injuries and 1 localized peritonitis. All patients were cured after conventional treatment. In the surgical group, most FBs were lodged in the descending part (55.6%). One patient developed localized peritonitis and one patient died of multiple organ failure. The significant features of FBs requiring surgery included FB over 10 cm, both sides perforation, multiple perforating FBs and massive pus overflow.ConclusionEndoscopic removal of duodenal perforating FBs is safe and effective, and can be the first choice of treatment for experienced endoscopists. Surgical intervention may be required for patients with FBs over 10 cm, both sides perforation, multiple perforating FBs, or severe infections.
Funder
National Natural Science Foundation of China
Program of Shanghai Academic Research Leader
Subject
Gastroenterology,Oncology