Jennifer Singleton1, Jesse M Schafer2, Jeremiah S Hinson3, Erin M Kane4, Sherieka Wright5, Beatrice Hoffmann6. 1. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, United States. Electronic address: jmsingle@bidmc.harvard.edu. 2. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, United States. Electronic address: jmschafe@bidmc.harvard.edu. 3. Department of Emergency Medicine, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Baltimore, MD 21287, United States. Electronic address: jeremiah.s.hinson@gmail.com. 4. Department of Emergency Medicine, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Baltimore, MD 21287, United States. Electronic address: ekane9@jhmi.edu. 5. Department of Emergency Medicine, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Baltimore, MD 21287, United States. Electronic address: sheriekawright895@hotmail.com. 6. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, United States. Electronic address: bhoffma2@bidmc.harvard.edu.
Abstract
BACKGROUND: Esophageal foreign body (EFB) and impaction are common gastrointestinal emergencies. Detection with standard imaging can be challenging. Computed tomography is a commonly used non-invasive imaging modality, but is not 100% sensitive and not always feasible. Sensitivity of plain film x-ray varies widely and the addition of a barium swallow can obscure evaluation by subsequent esophagogastroduodenoscopy (EGD). Use of emergency ultrasound (EUS) for detection of EFB in adults has not been previously studied. OBJECTIVE: To evaluate the role of EUS in detection of EFB and to characterize sonographic findings. METHODS: A case control series of five patients with clinical suspicion of EFB underwent EUS, and findings were compared to five healthy controls. Patients were evaluated for persistent air-fluid levels after swallowing, esophageal dilatation, and visualization of EFB. RESULTS: All patients with suspected EFB had esophageal dilatation (17.5mm vs 9.3mm in healthy controls; p=0.0011) and persistent air-fluid levels after swallowing. EFB was visualized on EUS in 60% of patients. All patients had EFB confirmed on EGD except one, who vomited a significant food bolus during EUS and prior to EGD. CONCLUSION: In patients with suspected EFB, point-of-care ultrasound may identify those with impaction. Suggestive findings include cervical esophageal dilatation and persistent intraluminal air-fluid levels after swallowing. EUS is a rapid, convenient test with the potential to expedite definitive management while decreasing cost and radiation exposure in this patient population.
BACKGROUND: Esophageal foreign body (EFB) and impaction are common gastrointestinal emergencies. Detection with standard imaging can be challenging. Computed tomography is a commonly used non-invasive imaging modality, but is not 100% sensitive and not always feasible. Sensitivity of plain film x-ray varies widely and the addition of a barium swallow can obscure evaluation by subsequent esophagogastroduodenoscopy (EGD). Use of emergency ultrasound (EUS) for detection of EFB in adults has not been previously studied. OBJECTIVE: To evaluate the role of EUS in detection of EFB and to characterize sonographic findings. METHODS: A case control series of five patients with clinical suspicion of EFB underwent EUS, and findings were compared to five healthy controls. Patients were evaluated for persistent air-fluid levels after swallowing, esophageal dilatation, and visualization of EFB. RESULTS: All patients with suspected EFB had esophageal dilatation (17.5mm vs 9.3mm in healthy controls; p=0.0011) and persistent air-fluid levels after swallowing. EFB was visualized on EUS in 60% of patients. All patients had EFB confirmed on EGD except one, who vomited a significant food bolus during EUS and prior to EGD. CONCLUSION: In patients with suspected EFB, point-of-care ultrasound may identify those with impaction. Suggestive findings include cervical esophageal dilatation and persistent intraluminal air-fluid levels after swallowing. EUS is a rapid, convenient test with the potential to expedite definitive management while decreasing cost and radiation exposure in this patient population.