S894 Real-World Management and Outcomes of Foreign Body-Associated Esophageal Perforations: A National Cohort Study

Introduction: Esophageal perforation is a rare, life-threatening condition often caused by foreign body ingestion. While endoscopic therapies are increasingly utilized, comparative outcome data across management strategies remain limited. We examined in-hospital outcomes, and the impact of intervention timing among patients managed endoscopically, surgically, or conservatively. Methods: We conducted a retrospective cohort study using the National Inpatient Sample, identifying adults hospitalized with foreign body-associated esophageal perforations from 2016-2022. Patients were categorized by treatment: endoscopic, surgical, or conservative. Primary outcomes included mortality, respiratory failure, sepsis, and hemorrhage. Logistic regression adjusted for age, comorbidities, and region. Results: Of 2,055 patients, 145 (7.1%) received endoscopic therapy, 190 (9.2%) underwent surgery, and 1,720 (83.7%) were treated conservatively. The majority (75.9%) of foreign bodies were food impactions. Mortality was 0% in the endoscopic group, vs 5.3% surgical and 2.9% conservative. Respiratory failure, defined as mechanical ventilation for greater than 24 hours, occurred in 17.2% of endoscopic patients vs 42.1% surgical (odds ratio 0.29; 95% confidence interval 0.09-0.92; P = 0.035). Sepsis was highest in surgical cases (29.0%) compared to endoscopic (10.3%) and conservative (15.4%). Conservative management had the highest hemorrhage rate (19.8%). Timing of intervention (same-day vs delayed) was not associated with any differences in mortality, respiratory failure, hemorrhage, or sepsis. Conclusion: Endoscopic therapy, though used in just 7% of cases, was associated with the favorable in-hospital outcomes, including no observed mortality and significantly lower odds of respiratory failure compared to surgery, supporting its broader adoption as first-line therapy in selected patients. Conversely, conservative management—applied to over 80% of cases—was linked to the highest rate of hemorrhage, raising concerns for delayed intervention or under-triage. Notably, outcomes did not significantly differ based on timing of intervention, suggesting early stabilization may mitigate procedural delay. These real-world findings challenge prevailing management patterns and underscore the need for structured triage algorithms, timely procedural access, and broader dissemination of advanced endoscopic capabilities.