<aside> 📘 Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline, 2016

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Highlights

Location	Condition	Timeframe
Esophagus	complete obstruction, sharp-pointed objects, batteries	Within 2-6 hours
Esophagus	the others	Within 24 hours
Stomach	sharp-pointed objects, magnets, batteries, large or long objects	Within 24 hours
Stomach	medium-sized blunt foreign bodies	Within 72 hours

Location	Maximum size to pass
Pylorus or ileocecal valve	2-2.5 cm in diameter
Duodenal sweep	5-6 cm in length

Timing of the endoscopy

Timing	Maximum Timeframe
Emergent	Within 6 hours
Urgent	Within 24 hours
Nonurgent	Within 72 hours

Object Type	Location	Timing
Battery	Esophagus	Emergent
	Stomach/small bowel	Urgent
Magnet	Esophagus	Urgent
	Stomach/small bowel	Urgent
Sharp-pointed foreign body	Esophagus	Emergent
	Stomach/small bowel	Urgent
Blunt and small foreign body <2-2.5 cm diameter	Esophagus	Urgent
	Stomach/small bowel	Nonurgent
Blunt and medium-sized foreign body > 2 - 2.5 cm diameter	Esophagus	Urgent
	Stomach/small bowel	Nonurgent
Large foreign body >5-6 cm	Esophagus	Urgent
	Stomach/small bowel	Urgent
Food bolus	Esophagus	Emergent (urgent if without symptoms or without complete obstruction)

Non-endoscopic measures

Evaluate patient's history and symptoms to diagnose foreign body ingestion and assess for complications.
Use plain radiography to locate and identify ingested foreign bodies.
Perform CT scan for suspected perforation or complications requiring surgery.
Avoid barium swallow due to risk of aspiration and poor visualization.
Observe asymptomatic patients with small, blunt objects without endoscopic removal, unless batteries or magnets are involved.
Observe asymptomatic individuals with concealed drug packets, but refer for surgery if suspected rupture, obstruction, or lack of progress.

Endoscopic measures

Emergent therapeutic endoscopy for complete obstruction/sharp-pointed objects/batteries in esophagus within 2-6 hours. Urgent endoscopy for other esophageal foreign bodies without complete obstruction within 24 hours.
Attempt gentle pushing of food bolus impaction into stomach, consider retrieval if unsuccessful. Medical treatment should not delay endoscopy.