Diagnostic Accuracy of Conventional Radiography for Esophageal Foreign Bodies in Adults

Background/Objective: Foreign body in the esophagus is a common emergency presentation. Conventional x-ray imaging is usually obtained to aid the diagnosis during the initial evaluation. The decision for surgical intervention is usually based on a suspicious history, physical examination and radiologic findings. Our hypothesis is that radiographic imaging should not alter the decision for surgical intervention in patients with a suspicious history and appropriate findings on physical examination. Patients and Methods: Seven hundred and five adult patients with suspected impaction of an esophageal foreign body were reviewed from 1994 to 2006 at Imam Khomeini Hospital, Ahwaz. Plain films were performed in every patient with suspected esophageal foreign body (EFB). Patients were included in this review if they were older than 15 years of age, initially presented for ingested foreign body evaluation, and underwent radiographic imaging prior to surgical intervention. Only adults satisfying all 3 criteria were included. Results: The study group contained 705 patients (528 male and 177 female) with the malefemale ratio of 3:1. Of the total 705 cases, 636 patients had a radiologic study suggestive of FB and 623 cases (98%) had an FB at the time of esophagoscopy. The remaining 69 patients did not have an FB at the time of esophagoscopy. The sensitivity and specificity of conventional radiographs in the diagnosis of an ingested FB were 100% and 84.2%, respectively. Chicken bones were the most frequently responsible foreign body and the area just below the cricopharyngeus muscle was the most frequent level of impaction. Rigid esophagoscopy was used successfully for foreign body removal in 97.6%. Conclusion: The approach towards a patient with a foreign body in the esophagus comprises a thorough history and systematic examination followed by relevant investigations. Ingested FBs are commonly investigated with cervical x-ray studies.