Radiographic and endoscopic management of unintentional versus intentional foreign body ingestion

Background and Objectives: Foreign body (FB) ingestion is a condition managed with esophagogastroduodenoscopy (EGD). This study compared the differences in demographics, utilization of imaging, endoscopic findings, and clinical outcomes between patients with unintentional versus intentional FB ingestion. Methods: Adult patients with FB ingestion, including food impactions, were included at a large tertiary academic medical system between 2010 and 2021 in this retrospective case series. Patients with unintentional ingestion of FBs (Group A) were compared to patients with intentional ingestion of FBs (Group B). Results: A total of 479 patients were included: 397 patients in Group A (83%) and 82 patients in Group B (17%). In Group A, 221 patients (56%) underwent imaging compared to 79 patients (96%) in Group B (P < 0.001). A FB was visible on imaging in 73 patients in Group A (34%) and 70 in Group B (89%) (P < 0.001). Group A patients more frequently underwent EGD after routine business hours (6 PM–7 AM) (40% vs. 27%, P = 0.03), and less frequently had ingested FBs identified on EGD (74% vs. 85%, P = 0.04). Excluding food impactions from Group A, imaging was utilized less frequently in Group A (80%) compared to Group B patients (96%) for evaluation of true FB ingestion (P = 0.016). Additionally, true FBs were visible on imaging less frequently in Group A (59%) than in Group B (87%) (P = 0.002). Conclusion: Unintentional FB ingestion patients were less likely to undergo imaging or to have FBs identified on imaging or EGD; They were more likely to undergo EGDs after routine business hours. Further investigation of the role of imaging in unintentional FB ingestion is needed to decrease unneeded emergent endoscopy for patients with FBs that are no longer easily reachable by EGD.