Intentional Swallowing of Foreign Bodies Is a Recurrent and Costly Problem That Rarely Causes Endoscopy Complications

Huang, Brian L.; Rich, Harlan G.; Simundson, Susan E.; Dhingana, Mukesh K.; Harrington, Colin; Moss, Steven F.

doi:10.1016/j.cgh.2010.07.013

« Previous Next »Clinical Gastroenterology and Hepatology
Volume 8, Issue 11 , Pages 941-946, November 2010

Intentional Swallowing of Foreign Bodies Is a Recurrent and Costly Problem That Rarely Causes Endoscopy Complications

Brian L. Huang
- Division of Gastroenterology, Department of Medicine, Rhode Island Hospital and Warren Alpert School of Medicine of Brown University, Providence, Rhode Island
Harlan G. Rich
- Division of Gastroenterology, Department of Medicine, Rhode Island Hospital and Warren Alpert School of Medicine of Brown University, Providence, Rhode Island
Susan E. Simundson
- Department of Clinical Management, Rhode Island Hospital, Providence, Rhode Island
Mukesh K. Dhingana
- Department of Clinical Management, Rhode Island Hospital, Providence, Rhode Island
Colin Harrington
- Departments of Medicine and Psychiatry, Rhode Island Hospital and Warren Alpert School of Medicine of Brown University, Providence, Rhode Island
Steven F. Moss
- Division of Gastroenterology, Department of Medicine, Rhode Island Hospital and Warren Alpert School of Medicine of Brown University, Providence, Rhode Island
- Reprint requests Address requests for reprints to: Steven F. Moss, MD, Division of Gastroenterology, Department of Medicine, Rhode Island Hospital, 593 Eddy St, APC 414, Providence, Rhode Island 02903. fax: (401) 444-2939

published online 09 August 2010.

Background & Aims

Guidelines support endoscopic removal of certain gastric foreign bodies (FBs) and all FBs lodged in the esophagus. We studied the poorly understood group of patients who intentionally ingest FBs.

Methods

Cases of intentional ingestion of FBs (n = 305) were identified, retrospectively, from an electronic endoscopy database and followed. Cases occurred among 33 different patients, who underwent endoscopy from October 1, 2001, to July 31, 2009 (39.0 cases/year); 79% were diagnosed with a psychiatric disorder. Financial cost analysis was performed using hospital billing and cost systems.

Results

Commonly ingested FBs included pens (23.6%), batteries (9.2%), knives (7.2%), and razor blades (6.9%). Most endoscopic procedures were performed under general anesthesia. FBs were commonly retrieved by snares (58.0%), rat-toothed forceps (14.4%), and nets (11.5%), assisted sometimes by use of overtubes (10.8%), and hoods (4.6%). FB extraction was unsuccessful at the initial endoscopy in only 20 cases; 2 cases eventually required surgical extraction. Minor complications occurred in 11 endoscopies. There were no deaths or perforations. The total estimated costs were $2,018,073 ($1,500,627 in hospital costs, $240,640 in physician fees, and $276,806 for security services). Costs were significantly higher for inpatients. Major payers were Medicare (48%) and Medicaid (31%).

Conclusions

Intentional FB ingestion occurs among a relatively small number of patients with psychiatric disorders and is costly. Endoscopic retrieval is relatively effective and safe, but often requires general anesthesia. These cases utilize significant hospital and fiscal resources. Attention should be focused on preventing these recurrent and costly episodes.

Keywords: Foreign Bodies, Deliberate Ingestion, Therapeutic Upper Gastrointestinal Endoscopy

Abbreviations used in this paper: ASPD, antisocial personality disorder, BLPD, borderline personality disorder, FB, foreign body, FBI, foreign body ingestion, SIB, self-injurious behavior