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Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and meta-analysis

BACKGROUND: Foreign body (FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy (FE) is recommended as the first-line therapeutic option because it can be performed under sedation, is cost-effective, and is well tolerated. Rigid endoscopy (RE) under general...

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Autores principales: Ferrari, Davide, Aiolfi, Alberto, Bonitta, Gianluca, Riva, Carlo Galdino, Rausa, Emanuele, Siboni, Stefano, Toti, Francesco, Bonavina, Luigi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134522/
https://www.ncbi.nlm.nih.gov/pubmed/30214470
http://dx.doi.org/10.1186/s13017-018-0203-4
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author Ferrari, Davide
Aiolfi, Alberto
Bonitta, Gianluca
Riva, Carlo Galdino
Rausa, Emanuele
Siboni, Stefano
Toti, Francesco
Bonavina, Luigi
author_facet Ferrari, Davide
Aiolfi, Alberto
Bonitta, Gianluca
Riva, Carlo Galdino
Rausa, Emanuele
Siboni, Stefano
Toti, Francesco
Bonavina, Luigi
author_sort Ferrari, Davide
collection PubMed
description BACKGROUND: Foreign body (FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy (FE) is recommended as the first-line therapeutic option because it can be performed under sedation, is cost-effective, and is well tolerated. Rigid endoscopy (RE) under general anesthesia is less used but may be advantageous in some circumstances. The aim of the study was to compare the efficacy and safety of FE and RE in esophageal FB removal. METHODS: PubMed, MEDLINE, Embase, and Cochrane databases were consulted matching the terms “Rigid endoscopy AND Flexible endoscopy AND foreign bod*”. Pooled effect measures were calculated using an inverse-variance weighted or Mantel-Haenszel in random effects meta-analysis. Heterogeneity was evaluated using I(2) index and Cochrane Q test. RESULTS: Five observational cohort studies, published between 1993 and 2015, matched the inclusion criteria. One thousand four hundred and two patients were included; FE was performed in 736 patients and RE in 666. Overall, 101 (7.2%) complications occurred. The most frequent complications were mucosal erosion (26.7%), mucosal edema (18.8%), and iatrogenic esophageal perforations (10.9%). Compared to FE, the estimated RE pooled success OR was 1.00 (95% CI 0.48–2.06; p = 1.00). The pooled OR of iatrogenic perforation, other complications, and overall complications were 2.87 (95% CI 0.96–8.61; p = 0.06), 1.09 (95% CI 0.38–3.18; p = 0.87), and 1.50 (95% CI 0.53–4.25; p = 0.44), respectively. There was no mortality. CONCLUSIONS: FE and RE are equally safe and effective for the removal of esophageal FB. To provide a tailored or crossover approach, patients should be managed in multidisciplinary centers where expertise in RE is also available. Formal training and certification in RE should probably be re-evaluated.
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spelling pubmed-61345222018-09-13 Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and meta-analysis Ferrari, Davide Aiolfi, Alberto Bonitta, Gianluca Riva, Carlo Galdino Rausa, Emanuele Siboni, Stefano Toti, Francesco Bonavina, Luigi World J Emerg Surg Review BACKGROUND: Foreign body (FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy (FE) is recommended as the first-line therapeutic option because it can be performed under sedation, is cost-effective, and is well tolerated. Rigid endoscopy (RE) under general anesthesia is less used but may be advantageous in some circumstances. The aim of the study was to compare the efficacy and safety of FE and RE in esophageal FB removal. METHODS: PubMed, MEDLINE, Embase, and Cochrane databases were consulted matching the terms “Rigid endoscopy AND Flexible endoscopy AND foreign bod*”. Pooled effect measures were calculated using an inverse-variance weighted or Mantel-Haenszel in random effects meta-analysis. Heterogeneity was evaluated using I(2) index and Cochrane Q test. RESULTS: Five observational cohort studies, published between 1993 and 2015, matched the inclusion criteria. One thousand four hundred and two patients were included; FE was performed in 736 patients and RE in 666. Overall, 101 (7.2%) complications occurred. The most frequent complications were mucosal erosion (26.7%), mucosal edema (18.8%), and iatrogenic esophageal perforations (10.9%). Compared to FE, the estimated RE pooled success OR was 1.00 (95% CI 0.48–2.06; p = 1.00). The pooled OR of iatrogenic perforation, other complications, and overall complications were 2.87 (95% CI 0.96–8.61; p = 0.06), 1.09 (95% CI 0.38–3.18; p = 0.87), and 1.50 (95% CI 0.53–4.25; p = 0.44), respectively. There was no mortality. CONCLUSIONS: FE and RE are equally safe and effective for the removal of esophageal FB. To provide a tailored or crossover approach, patients should be managed in multidisciplinary centers where expertise in RE is also available. Formal training and certification in RE should probably be re-evaluated. BioMed Central 2018-09-12 /pmc/articles/PMC6134522/ /pubmed/30214470 http://dx.doi.org/10.1186/s13017-018-0203-4 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review
Ferrari, Davide
Aiolfi, Alberto
Bonitta, Gianluca
Riva, Carlo Galdino
Rausa, Emanuele
Siboni, Stefano
Toti, Francesco
Bonavina, Luigi
Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and meta-analysis
title Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and meta-analysis
title_full Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and meta-analysis
title_fullStr Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and meta-analysis
title_full_unstemmed Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and meta-analysis
title_short Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and meta-analysis
title_sort flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134522/
https://www.ncbi.nlm.nih.gov/pubmed/30214470
http://dx.doi.org/10.1186/s13017-018-0203-4
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