Esophageal Foreign Body in Emergency Medicine: Rapid Risk Stratification, Airway Protection, and Evidence-Based Endoscopic Referral Pathways

Background: Esophageal foreign body ingestion is a frequent emergency presentation across all age groups, ranging from benign events to life-threatening complications. Rapid risk stratification and timely intervention are critical to prevent airway compromise, perforation, and mediastinal contamination.Aim: To review the clinical approach to esophageal foreign body management in emergency medicine, emphasizing risk assessment, diagnostic strategies, and evidence-based endoscopic referral pathways.Methods: A comprehensive synthesis of current literature and clinical guidelines was performed, focusing on epidemiology, pathophysiology, diagnostic imaging, and management algorithms for high-risk objects such as button batteries, magnets, and sharp items.Results: Children account for approximately 80% of cases, with coins being the most common ingested object, while adults predominantly present with food bolus impaction. High-risk objects (button batteries, multiple magnets, sharp items) demand emergent endoscopic removal due to rapid tissue injury mechanisms. Plain radiography remains the first-line diagnostic tool, but CT and endoscopy are essential when radiolucent objects or complications are suspected. Endoscopic retrieval achieves >90% success with <5% complication rates. Pharmacologic adjuncts like glucagon show limited benefit and should not delay definitive intervention.Conclusion: Effective management requires early recognition of high-risk scenarios, airway protection, and timely endoscopic intervention. Multidisciplinary coordination and structured observation protocols improve outcomes and reduce morbidity.