Introduction
Methods
Study design
Study population
ICD-10 codes | Description | Specific codes (possible FBO) (S), unspecific codes (FBO could not be excluded) (U), and excluded codes (E) |
---|---|---|
DC15-16 + DC26 | Neoplasm in the gastrointestinal canal, primarily in the oral cavity and the oesophagus | S |
DF06 | Organic psychiatric disorders | S |
DG00-DG26 + DG30-DG32 + DG35-DG37 + DG51 + DG70-DG73 + DG80-DG83 | Neurological disorders and muscular diseases | E |
DK20-23 | Oesophageal diseases | S |
DR | Symptoms and abnormal findings | (U) |
- DR139 | Dysphagia without any further clarification | S |
DT180-181 + DT189 | Foreign body/food bolus impaction in the gastrointestinal canal, primarily the oral cavity and the oesophagus. | S |
DZ | Factors that influence health and contact with the healthcare system | U |
Procedure codes | ||
KGE | Mediastinal surgery | S |
KJC | Oesophageal surgery | S |
KJN | Reconstructive surgery following gastrointestinal surgery | S |
KJW | Reoperation after gastrointestinal surgery | S |
KUJ | Endoscopy of the gastrointestinal canal | S |
Data collection
Data analysis and results
Results
FBO patients were often older and had often experienced FBO previously
Patients, n | 150 |
---|---|
Age at hospital visit, median (Q1-Q3) | 66.0 (49.8–81.0) |
Male sex, % (n) | 58.7% (88) |
Previous FBO, % (n) | 55.3% (83) |
Diagnoses with relevance to FBO prior to hospital visit, % (n) | |
No diagnoses | 83.3% (125) |
Oesophageal stricture | 7.3% (11) |
Eosinophilic oesophagitis | 5.3% (8) |
Achalasia | 2.0% (3) |
Oesophageal or gastric cardia cancer | 2.0% (3) |
Previous fundoplication surgery | 1.3% (2) |
Hospitalised during the acute hospital visit, % (n) | 70.0% (105) |
Patient was initially examined by a physician from, % (n) | |
Department of Emergency medicine | 56.0% (84) |
Department of Ear nose and throat | 28.0% (42) |
Department of Surgery | 13.3% (20) |
Nurse | 2.0% (3) |
Department of Oncology | 0.7% (1) |
Patient underwent upper endoscopy, % (n) | 79.3% (119) |
Within the acute hospital visit | 62.0% (93) |
From discharge to 2 weeks after discharge | 6.0% (9) |
From 2 weeks to 6 months after discharge | 10.0% (15) |
Later than 6 months after discharge | 1.3% (2) |
No upper endoscopy | 20.7% (31) |
Patient was biopsied in the oesophagus, % (n) | 48.7% (73) |
Within the acute hospital visit | 24.0% (36) |
From discharge to 2 weeks after discharge | 4.0% (6) |
From 2 weeks to 6 months after discharge | 17.3% (26) |
Later than 6 months after discharge | 3.3% (5) |
No biopsies taken | 51.3% (77) |
Number of oesophageal biopsies sampled, median (Q1-Q3) | 8.0 (6.0–8.0) |
Reoccurrence of oesophageal FBO, % (n) | 16.7% (25) |
National guidelines on endoscopy and oesophageal biopsies were often not followed
Effective treatment of FBO only involved endoscopic removal in half of patients
Endoscopic findings at initial endoscopy during or after FBO | Within the acute hospital visit, % (n = 93) | From discharge to 2 weeks after discharge, % (n = 9) | Later than 2 weeks after, % (n = 17) |
---|---|---|---|
Food bolus | 84.9% (79) | 22.2% (2) | 5.9% (1) |
Stricture | 12.9% (12) | 11.1% (1) | 5.9% (1) |
Other types of oesophagitis | 9.7% (9) | 11.1% (1) | 5.9% (1) |
Edema | 9.7% (9) | 0% | 5.9% (1) |
White spots | 7.5% (7) | 0% | 0% |
Reflux oesophagitis | 6.5% (6) | 11.1% (1) | 11.8% (2) |
Malignancy | 2.2% (2) | 0% | 0% |
Schatzki rings | 1.1% (1) | 22.2% (2) | 0% |
Exudates | 1.1% (1) | 0% | 0% |
Furrows | 0% | 0% | 5.9% (1) |
Food causing FBO, % (n) | |||
Meat (beef, veal or pork) | 52.0% (78) | ||
Poultry | 13.3% (20) | ||
No clarification or unclear | 10.7% (16) | ||
Combinations of food (e.g., meat and potatoes, chicken and rice) | 8.7% (13) | ||
Vegetables or fruit | 6.0% (9) | ||
Bread | 2.7% (4) | ||
Other: tablets, fish or shellfish, candy, or oats | 6.7% (10) | ||
Treatment of FBO during the acute hospital visit, % (n) | |||
Spontaneous resolution | 7.3% (11) | ||
Treated with 1st step: sparkling water | 68.0% (102) | ||
Sparkling water alone resolved the FBO | 25.3% (38) | ||
Treated with 2nd step: injection of muscle relaxant | 29.3% (44) | ||
Injection of muscle relaxant alone | 0% | ||
Injection of muscle relaxant and sparkling water alone | 10.0% (15) | ||
Needed 3rd step: endoscopic removal of FBO | 48.7% (73) | ||
Endoscopic removal of FBO alone | 14.0% (21) | ||
Oesophageal stent | 0.7% (1) | ||
Treatment initiated at discharge, % (n) | |||
PPI | 49.3% (74) | ||
None | 51.3% (77) | ||
Antimycotics or antibiotics | 6.0% (9) | ||
Oesophageal dilation | 2.0% (3) |
A majority of patients with FBO never got a causal diagnosis
Diagnoses, with relevance to FBO, following the acute hospital visit (including prior known diagnoses), % (n) | |
---|---|
No diagnoses | 76.0% (114) |
Oesophageal stricture | 14.0% (21) |
EoE | 8.7% (13) |
Achalasia | 2.0% (3) |
Oesophageal or gastric cardia cancer | 2.0% (3) |
Previous fundoplication surgery | 1.3% (2) |
Schatzki ring | 0.7% (1) |
Diagnosis, with relevance to FBO, following later hospital visits related to the initial hospital visit with FBO, or unrelated due to reoccurrence of FBO (including prior known diagnoses), % (n) | |
No diagnoses | 66.0% (99) |
EoE | 17.3% (26) |
Oesophageal stricture | 15.3% (23) |
Oesophageal or gastric cardia cancer | 5.3% (8) |
Schatzki ring | 4.0% (6) |
Achalasia | 2.7% (4) |
Previous fundoplication surgery | 1.3% (2) |