A national retrospective analysis of the management of patients presenting as an emergency with a foreign body in the oesophagus

Abstract Background and Aims Emergency a dmission with foreign body in the oesophagus (FBO) commonly requires endoscopic removal. Oesophageal food bolus obstruction is often due to eosinophilic oesophagitis (EoE). Patients with food bolus obstruction should undergo endoscopy and multilevel oesophageal biopsies to exclude EoE. This national retrospective study examined the management, including endoscopy and follow-up, of patients presenting as an emergency with FBO. Methods The Hospita l Episode Statistics database was used to identify patients over 18 with FBO presenting as an emergency in England using the ICD-10 code T18.1 between 2008 and 2019. Logistic regression analysis was used to assess factors associated with undergoing endoscopy and biopsy. Results 27,063 patients were identified: 65.5% male; median age 57(IQR 41-73) years; and 47.2% were admitted under Ear, Nose & Throat (ENT). 75.7% underwent endoscopy (94% within a week of admission) but only 19.8% had biopsies taken within 6 months of admission. 0.4% were coded with a perforation related to endoscopy for FBO. 70% of ENT patients underwent endoscopy but only 11.9% had biopsy to exclude EOE, compared with 83% of patient admitted under General Medicine undergoing endoscopy and 29.5% biopsy. Endoscopy and biopsy was associated with: older age (e.g. 61-70 OR 1.42 (95% CI 1.26-1.61)), males (females 0.67(0.62-0.72)), the least deprived (1.25 (1.13-1.38)), later diagnosis year (2019 1.42 (1.21-1.66)), and admission under General Medicine (2.68(2.48-2.88)) or Gastroenterology (3.03(2.61-3.51)) but not with NHS trust FBO volume. 33.4% received relevant outpatient follow-up within 12 months of FBO admission: 26% of patients admitted under General Medicine were referred to gastroenterology for follow-up, but only 12.1% of those admitted under ENT. Conclusions 75.7% of patients presenting with FBO undergo endoscopy but few (19.8%) had biopsies taken to exclude this common presentation of EOE. Pathways for the management of food bolus obstruction require re-design and unless the airway is impaired, this condition should be managed under General Medicine.