In our study, we observed that complications of erosion were significantly more common on holidays than on weekdays. It is noted that type of FB was the only risk factor related with complications on holidays. Previous study showed that patients with esophageal food bolus impaction had significant fewer complications and higher proportions of esophageal cancer, which is consistent with our result. Patients with impaction of food bolus had lower complications than those with ingestion of nonfood bolus, probably due to that food bolus is different from bone and jujube shell, which have sharp edge. In addition, we found that the type of jujube shell and nonfood bolus was, respectively, committed to complications on weekdays and holidays. In particular, patients with jujube shell ingested were more likely to be female, old, and get complications. Since the first report in 1972 on the endoscopic removal of a FB, flexible endoscopy has been the first choice for esophageal food bolus impaction with high success rate and less complications. Endoscopic removal is characterized by technical facility, excellent visualization, simultaneous diagnosis of other diseases, and a low rate of morbidity. European Society of Gastrointestinal Endoscopy suggests treatment of food bolus impaction in the esophagus by gently pushing the bolus into the stomach. If this procedure is not successful, retrieval should be considered and a repeat endoscopy should be carried out after extraction of foreign bodies in all patients to detect any underlying disease. Nevertheless, in clinical endoscopic practice, if the risk of esophageal perforation and bleeding is high, as in those cases with sharpened or pointed foreign bodies deeply fixed into the wall, it is better to avoid any endoscopic attempts and to resort to surgery. According to our study, the older women were suggested to change their eating habits or eat non-nuclear jujube. At the same time, a latex protector hood or an overtube especially should be taken for patients with ingestion of nonfood bolus in order to protect the esophageal mucosa during procedure on holidays.
In our center, the endoscopic procedure was performed in most of the patients within 24 hours, because the foreign bodies had not passed through the upper-GI tract. Some studies have shown that long duration from ingestion to endoscopy and mucosal injury were risk factors of complications of endoscopic FB removal. On the contrary, Huang et al have shown that longer wait times are not associated with mucosal injury or postoperative complication. Given the study participants consisted of children, which was different from other researches, more data need to be collected to support this view. However, our investigation was limited by obtaining accurate waiting time from ingestion to endoscopy. Limitations also include the absence of diameter size of ingested foreign bodied, which was identified as a risk factor predicting conversion to surgery due to inability to remove the FB endoscopically. In addition, duration of endoscopic performance may influence treatment outcome, although no study has shown evidence to support this.
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