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    Home > Active Ingredient News > Digestive System Information > The latest guidelines for the management of foreign bodies in the digestive tract of children put forward 12 recommendations!

    The latest guidelines for the management of foreign bodies in the digestive tract of children put forward 12 recommendations!

    • Last Update: 2022-01-27
    • Source: Internet
    • Author: User
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    Gastrointestinal foreign body is one of the most common critical illnesses in gastroenterology, and it is the most common in children
    .

    The "Guidelines for the Management of Foreign Bodies in the Digestive Tract in Children in China (2021)" form evidence-based recommendations, in order to guide and promote the diagnosis and treatment of foreign bodies in the digestive tract of children in a more standardized and scientific manner by clinicians of all levels and types who receive foreign bodies in the digestive tract of children , so as to optimize the management of foreign bodies in the digestive tract of children in an all-round way
    .

    Clinical Question 1 What are the imaging methods for gastrointestinal foreign bodies in children? Recommendation 1: X-ray examination is recommended for suspected foreign body swallowing, but barium meal is not recommended (2C)
    .

    When X-ray examination is negative, it is still highly suspected of foreign body swallowing, or when it is necessary to further clarify the location of the foreign body and complications, CT examination is recommended (1B)
    .

    Ultrasonography may also be considered in the detection of gastrointestinal foreign bodies and their complications in children (2B)
    .

    Clinical Question 2 What are the indications for endoscopic surgery for gastrointestinal foreign bodies in children? How to choose the time? Recommendation 2: Endoscopic surgery is suitable for the removal of foreign bodies in the gastrointestinal tract that cannot be discharged on their own without serious complications, but the optimal timing of removal (GPS) should be selected according to the type, size, location and time of the foreign body
    .

    Emergency endoscopy is recommended in the following situations: (1) various foreign bodies in the esophagus cause clinical symptoms, accompanied by obstruction or stay for more than 24 hours; (2) blunt foreign bodies in the stomach or duodenum cause gastrointestinal obstruction (3) Sharp foreign bodies, button batteries and multiple magnetic foreign bodies or magnetic foreign bodies combined with metals located in the esophagus, stomach or duodenum (Note: Elective endoscopic surgery is recommended when the button battery is located in the stomach and asymptomatic).
    ) (2C)
    .

    Elective endoscopy is recommended in the following situations: (1) foreign bodies located in the esophagus do not cause clinical manifestations or are not accompanied by obstruction; (2) foreign bodies located in the stomach or duodenum cause clinical manifestations, but do not meet the indications for emergency endoscopy; (3) Foreign bodies with a diameter of ≥ 2.
    5 cm or a length of ≥ 6.
    0 cm in the stomach, single magnetic foreign bodies or other foreign bodies that have not been discharged within 1 to 2 weeks (GPS)
    .

    Clinical Question 3 What are the indications for the follow-up observation of foreign bodies in the digestive tract of children? Recommendation 3: For children who accidentally swallow a single small blunt foreign body (such as magnetic foreign bodies, small button batteries, and coins) and have no obvious clinical symptoms, if the foreign body can migrate in the gastrointestinal tract, clinical observation and outpatient follow-up are recommended (2C)
    .

    Clinical Question 4 What are the indications for surgical treatment of gastrointestinal foreign bodies in children? Recommendation 4: For high-risk patients with complete obstruction, severe perforation, fistula formation, and other serious complications, or patients with failed endoscopic removal and failure to prevent complications, surgery is recommended as soon as possible (1D)
    .

    For blunt foreign bodies that have passed through the duodenum, surgery is recommended if there is clinical symptoms or no progression on imaging for more than 7 days, or if endoscopic removal cannot be performed (2C)
    .

    For sharp foreign bodies that have passed through the duodenum, surgery is recommended if there are clinical symptoms or no progression on imaging for more than 3 days, or if endoscopic removal cannot be performed (2C)
    .

    Aggressive surgery is recommended for drug packs that cannot be excreted spontaneously or that present with intestinal obstruction (2D)
    .

    Clinical Question 5 What are the commonly used techniques for endoscopic surgery for gastrointestinal foreign bodies in children? Recommendation 5: When removing a foreign body, it is recommended that the direction of the long axis of the foreign body be consistent with the direction of the alimentary canal lumen (GPS)
    .

    Caution should be exercised when taking out large foreign bodies.
    It is recommended to inflate and take out (GPS) at the same time
    .

    After the foreign body reaches the upper end of the esophagus, it is recommended to tilt the patient's jaw back and remove the foreign body (GPS)
    .

    When performing endoscopic surgery for gastrointestinal foreign bodies in children, it is recommended to select appropriate instruments (GPS) according to the characteristics of foreign bodies
    .

    Clinical Question 6 What are the key points of perioperative management of endoscopic surgery for gastrointestinal foreign bodies in children? Recommendation 6: It is recommended to comprehensively collect the patient's medical history before surgery, including the type, size, number, shape and location of the foreign body, the time of mistakenly swallowing the foreign body, and the time of the last meal (1C)
    .

    It is recommended to inform the patient's parents or legal guardians of the surgical process, risks and complications before surgery, and ask them to sign an informed consent form (GPS)
    .

    It is recommended that patients fast for 6-8 hours and water for at least 2 hours before elective endoscopic surgery; fasting and water time can be relaxed as appropriate before emergency endoscopic surgery (2C)
    .

    It is recommended that patients undergo routine and necessary laboratory tests and auxiliary tests such as blood routine, coagulation function, liver and kidney function, pre-transfusion examination, electrocardiogram, and chest X-ray before surgery (1C)
    .

    For bowel preparation before the removal of lower gastrointestinal foreign bodies through ano-enteroscopy or colonoscopy: saline enema is recommended for patients <2 years old, and polyethylene glycol electrolyte powder or lactulose can also be considered; patients ≥2 years old are recommended High-dose fractionated polyethylene glycol electrolyte powder (2C)
    .

    Clinical Question 7 What is the process for children who accidentally swallow button batteries? Recommendation 7: When the button battery is located in the esophagus, emergency endoscopic removal is recommended (1B)
    .

    When the button battery is in the stomach and asymptomatic, elective endoscopy and periodic X-rays are recommended to monitor its expulsion
    .

    When the button battery is located in the stomach, emergency endoscopic removal is recommended: (1) the patient has gastrointestinal symptoms; (2) multiple button batteries are swallowed at the same time; (3) the button battery stays in the stomach for more than 48 hours ; (4) Button battery diameter ≥ 20mm (2D)
    .

    When the button battery has passed through the duodenum, it is recommended to perform X-ray examination every 1 to 2 days to track the migration of the battery until the battery is discharged from the body (2C)
    .

    Clinical Question 8 What is the treatment process for a child who accidentally swallowed a jujube pit (sharp foreign body)? Recommendation 8: For jujube pits (sharp foreign bodies) in the esophagus, stomach, and duodenum, regardless of gastrointestinal symptoms, emergency endoscopic removal is recommended (2C)
    .

    For the jujube core (sharp foreign body) that has passed through the duodenum, if there are no symptoms, it is recommended to follow up and observe; if there are signs of intestinal obstruction or intestinal perforation, surgical removal (GPS) is recommended
    .

    Clinical Question 9 What is the treatment process for children who accidentally swallow multiple magnetic foreign bodies? Recommendation 9: Emergency endoscopic treatment is recommended for multiple magnetic foreign bodies retained in the esophagus, stomach and duodenum (2D)
    .

    When gastroscopy cannot be removed or cannot be removed completely, and the patient has no clinical symptoms, close observation is recommended when multiple magnetic foreign bodies continue to migrate; if multiple magnetic foreign bodies continue to stay in the same position or clinical symptoms appear, surgical treatment is recommended; When a gastrointestinal perforation is found on exploration, surgical management is recommended (2D)
    .

    Clinical Question 10 What is the management process for children with gastrolithiasis? Recommendation 10: For vegetative gastrolithiasis, when the gastrolith is small in size and soft in texture, it is recommended to use drugs or other solubilizing substances to dissolve it and wait for it to be excreted naturally; For lithotripsy, endoscopic treatment is recommended; when lithotripsy combined with endoscopic treatment fails or is complicated by serious complications, surgical treatment is recommended (2C)
    .

    For trichomes, endoscopic lithotripsy can be considered if the gastrolith volume is small, and surgical treatment is recommended when endoscopic lithotripsy treatment fails (2D)
    .

    Clinical question 11 Which anesthesia method should be selected for endoscopic surgery for gastrointestinal foreign bodies in children? Recommendation 11: Endoscopic surgery for gastrointestinal foreign bodies in children is recommended under general anesthesia (1B)
    .

    General anesthesia with endotracheal intubation is recommended for patients who are expected to have a longer operative time or are <1 year old (1D)
    .

    Clinical question 12What are the risk factors and management methods of gastrointestinal foreign body complications in children? Recommendation 12: Risk factors for gastrointestinal foreign body complications in children mainly include patient age (<3 years old), foreign body shape or length (sharp foreign body, long foreign body), foreign body type and nature (magnetic foreign body, button battery, metal, plastic , corrosive substances), number of foreign bodies (≥2), foreign body retention time (>24h), foreign body incarcerated location (esophagus), and underlying diseases (including children's digestive tract malformations, swallowing disorders, achalasia and esophagitis, etc.
    ) (2C)
    .

    In children with foreign bodies in the digestive tract complicated by mucosal oozing or a small amount of bleeding, topical drugs are recommended for hemostasis.
    If small blood vessels are ruptured, metal clips, ligatures, or high-temperature coagulation are recommended for hemostasis (2C)
    .

    When foreign bodies in the digestive tract of children are complicated by perforation, it is recommended that small fistulas be closed with metal clips or combined with nylon rope snare, and larger esophageal fistulas should be treated with stent-graft or surgical treatment.
    If there is exudation or infection before closing the fistula Drainage and antibiotic therapy are required (2C)
    .

    In children with gastrointestinal foreign bodies complicated by lumen stenosis, endoscopic treatment is recommended (2C)
    .

    The above content is excerpted from: Pediatric Collaborative Group of Digestive Endoscopy Branch of Chinese Medical Association, Pediatric Digestive Endoscopy Professional Committee of Endoscopy Branch of Chinese Medical Doctor Association.
    Guidelines for the management of gastrointestinal foreign bodies in children in China (2021) [J].
    China Gastrointestinal Endoscopy Electronics Journal, 2021, 8(4):147-163.

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