A prospective randomized trial comparing the use of flexible gastroscope versus bronchoscope in the management of foreign body ingestion

Background Foreign body ingestion is a common clinical problem in Hong Kong. Some recent reports have proposed the use of flexible bronchoscope for foreign body retrieval. The present study is a prospective randomized trial on the use of flexible gastroscope and bronchoscope in the management of foreign body ingestion. Methods Between December 1995 and June 1996, 216 patients older than 11 years were prospectively randomized to flexible endoscopic examination using either the gastroscope (108 patients) or the bronchoscope (108 patients) under local pharyngeal anesthesia. The duration of procedure and the type of foreign body retrieved were noted. On conclusion of the endoscopie examination, patients were asked to assess their overall tolerance to the procedure on a scale of 1 (well tolerated) to 10 (unacceptable). Results There was a preponderance of female patients (M : F = 72 : 144). Mean age was 46 years (range, 12 to 85 years). A foreign body was retrieved in 68 patients (31.5%). There was no difference between the two groups in the foreign body retrieval rate, type of foreign body retrieved, duration of procedure, and tolerance level. In the group managed with the bronchoscope, however, three patients required the additional use of the gastroscope for foreign body retrieval at (one patient) or below (two patients) the cricopharyngeus. Patient's tolerance level was related only to the duration of procedure in the GE group (rho = 0.444; p < 0.001), BE group (rho = 0.388; p < 0.001), and in the whole group (rho = 0.386; p < 0.001). Conclusion The use of the flexible gastroscope is recommended because of its efficacy, safety, and tolerability.