Pediatric gastrointestinal foreign bodies: characteristics and risk factors for complications_West China Medical Journal

Authors：

YIN Fang ^1,2 , ZHU Min ² , LIN Hao ^1,2 , PANG Jiangmei ^1,2 , CHEN Jingjing ^1,2 ,  ZHANG Hu ^1,2

1. Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Centre for Inflammatory Bowel Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHANG Hu, Email: zhanghu@scu.edu.cn

Keywords：

Foreign body in digestive tract; children; complication; risk factor

DOI：

10.7507/1002-0179.202502076

Video：

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Objective To investigate the characteristics, complications, and influencing factors of pediatric foreign body ingestion, providing clinical references for prevention and management. Methods A retrospective analysis was conducted on pediatric cases of foreign body ingestion treated at West China Hospital of Sichuan University between June 2007 and September 2019. Patients were stratified by age into ≤5 years, 6-10 years, and >10 years groups. Foreign body types, impaction sites, and complication rates were compared across age groups. Univariate analysis and multivariate logistic regression were performed to identify risk factors for complications. Results A total of 610 pediatric cases of foreign body ingestion were enrolled. Foreign body ingestion predominantly occurred in children ≤5 years (n=472, 77.38%), followed by 6-10 years (n=100, 16.39%) and >10 years (n=38, 6.23%). Foreign body types varied significantly by age (P<0.05): coins predominated in ≤5-year-olds (57.20%), while food-related objects were most common in >10-year-olds (52.63%). The most frequent impaction site was the upper esophagus, accounting for 48.31%, 44.00%, and 60.53% in the three age groups, respectively. Univariate analysis identified age, foreign body type, and location as significant predictors of complications (P<0.05). Multivariate logistic regression demonstrated that oropharynx and esophageal impaction (reference: stomach) [odds ratio (OR)=4.699, 95% confidence interval (CI) (2.456, 8.996), P<0.001] and high-risk foreign body types [OR=3.538, 95%CI (2.045, 6.122), P<0.001] were independent risk factors for complications, whereas increasing age had a protective effect [OR=0.418, 95%CI (0.252, 0.694), P=0.001]. Conclusions Younger children are at higher risk of foreign body ingestion, while increasing age is protective against complications. High-risk foreign body types and oropharynx and esophageal impaction significantly increase complication risks. Strengthening parental education, preventive measures against high-risk objects, and enhancing clinicians’ vigilance for complex cases are essential to reduce complications.

1.	中华医学会消化内镜学分会儿科协作组, 中国医师协会内镜医师分会儿科消化内镜专业委员会. 中国儿童消化道异物管理指南(2021). 中国循证医学杂志, 2022, 22(1): 2-18.
2.	Orsagh-Yentis D, McAdams RJ, Roberts KJ, et al. Foreign-body ingestions of young children treated in US emergency departments: 1995-2015. Pediatrics, 2019, 143(5): e20181988.
3.	Lee JH. Foreign body ingestion in children. Clin Endosc, 2018, 51(2): 129-136.
4.	Bekkerman M, Sachdev AH, Andrade J, et al. Endoscopic management of foreign bodies in the gastrointestinal tract: a review of the literature. Gastroenterol Res Pract, 2016, 2016: 8520767.
5.	Khorana J, Tantivit Y, Phiuphong C, et al. Foreign body ingestion in pediatrics: distribution, management and complications. Medicina (Kaunas), 2019, 55(10): 686.
6.	Low Kapalu CM, Uraizee O, Lerner DG, et al. Endoscopist experience with pediatric recurrent and intentional foreign body ingestion (RIFBI): management considerations and future directions. J Pediatr Gastroenterol Nutr, 2024, 78(3): 711-719.
7.	陈文博, 周子濡, 李琦, 等. 204 例硬币类儿童食管异物自行越过食管相关因素分析. 临床耳鼻咽喉头颈外科杂志, 2018, 32(9): 653-655.
8.	Mantegazza C, Destro F, Ferraro S, et al. Recent trends in foreign body ingestion (FBI) epidemiology: a national cohort study. Dig Liver Dis, 2025, 57(2): 595-602.
9.	Calini G, Ortolan N, Battistella C, et al. Endoscopic failure for foreign body ingestion and food bolus impaction in the upper gastrointestinal tract: an updated analysis in a European tertiary care hospital. Eur J Gastroenterol Hepatol, 2023, 35(9): 962-967.
10.	Xu G, Chen YC, Chen J, et al. Management of oesophageal foreign bodies in children: a 10-year retrospective analysis from a tertiary care center. BMC Emerg Med, 2022, 22(1): 166.
11.	Privato R, Pezzoli F, Barni S, et al. Esophageal food bolus impaction in children: a 15-year experience and a review. J Pediatr Gastroenterol Nutr, 2025, 80(1): 57-68.
12.	Fung BM, Sweetser S, Wong Kee Song LM, et al. Foreign object ingestion and esophageal food impaction: an update and review on endoscopic management. World J Gastrointest Endosc, 2019, 11(3): 174-192.
13.	Karb D, DeLozier S, Raad D, et al. Effect of delayed endoscopy protocol on timing and safety of endoscopy for foreign body ingestion and esophageal food impaction. J Clin Gastroenterol, 2023, 57(9): 890-894.
14.	Kumar R, Soni N, Bhardwaj S, et al. Intentional foreign body ingestion. Intern Emerg Med, 2019, 14(8): 1331-1333.
15.	Turgut K, Poyraz MK, Sekmen E, et al. Prevalence of attention deficit hyperactivity disorder (ADHD) in children presenting with foreign body ingestion. Am J Emerg Med, 2019, 37(12): 2121-2124.
16.	Navia-López LA, Cadena-León JF, Ignorosa-Arellano KR, et al. Foreign body ingestion and associated factors in pediatric patients at a tertiary care center. Rev Gastroenterol Mex (Engl Ed), 2022, 87(1): 20-28.
17.	Smetak MR, Wilcox LJ. Button-battery ingestion. N Engl J Med, 2024, 391(12): 1139.
18.	Lorenzo C, Azevedo S, Lopes J, et al. Battery ingestion in children, an ongoing challenge: recent experience of a tertiary center. Front Pediatr, 2022, 10: 848092.
19.	Nugud AA, Tzivinikos C, Assa A, et al. Pediatric magnet ingestion, diagnosis, management, and prevention: a European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) position paper. J Pediatr Gastroenterol Nutr, 2023, 76(4): 523-532.
20.	Jin Y, Gao Z, Zhang Y, et al. Management of multiple magnetic foreign body ingestion in pediatric patients. BMC Pediatr, 2022, 22(1): 448.
21.	Lu D, Lv L, Gu Q, et al. Extraction of fish bones embedded in the esophagus via endoscopic submucosal dissection: two case reports and literature review. Front Med (Lausanne), 2021, 8: 746720.
22.	Díaz Granados A, Dabán López P, Jurado Prieto FJ, et al. Acute pancreatitis due to fishbone. Rev Esp Enferm Dig, 2024.
23.	Xiao JB, Siu JM, Propst EJ, et al. Consumer trends reflected in the contents of the pediatric esophagus: a 20-year review. Laryngoscope, 2025, 135(1): 438-444.
24.	Zhang M, Wan J, Zhou Q. Time trends and endoscopic management of foreign body ingestion in the upper GI tract: a retrospective analysis of 1, 152 cases in China. Revista Espanola De Enfermedades Digestivas, 2023, 115(9): 488-495.
25.	He Z, Xu Q, Fan W, et al. Non-foreign body-associated risk factors for complications associated with esophageal foreign-body removal and timing of endoscopic treatment: a single-center retrospective study. BMC Gastroenterol, 2024, 24(1): 429.

1. 中华医学会消化内镜学分会儿科协作组, 中国医师协会内镜医师分会儿科消化内镜专业委员会. 中国儿童消化道异物管理指南(2021). 中国循证医学杂志, 2022, 22(1): 2-18.
2. Orsagh-Yentis D, McAdams RJ, Roberts KJ, et al. Foreign-body ingestions of young children treated in US emergency departments: 1995-2015. Pediatrics, 2019, 143(5): e20181988.
3. Lee JH. Foreign body ingestion in children. Clin Endosc, 2018, 51(2): 129-136.
4. Bekkerman M, Sachdev AH, Andrade J, et al. Endoscopic management of foreign bodies in the gastrointestinal tract: a review of the literature. Gastroenterol Res Pract, 2016, 2016: 8520767.
5. Khorana J, Tantivit Y, Phiuphong C, et al. Foreign body ingestion in pediatrics: distribution, management and complications. Medicina (Kaunas), 2019, 55(10): 686.
6. Low Kapalu CM, Uraizee O, Lerner DG, et al. Endoscopist experience with pediatric recurrent and intentional foreign body ingestion (RIFBI): management considerations and future directions. J Pediatr Gastroenterol Nutr, 2024, 78(3): 711-719.
7. 陈文博, 周子濡, 李琦, 等. 204 例硬币类儿童食管异物自行越过食管相关因素分析. 临床耳鼻咽喉头颈外科杂志, 2018, 32(9): 653-655.
8. Mantegazza C, Destro F, Ferraro S, et al. Recent trends in foreign body ingestion (FBI) epidemiology: a national cohort study. Dig Liver Dis, 2025, 57(2): 595-602.
9. Calini G, Ortolan N, Battistella C, et al. Endoscopic failure for foreign body ingestion and food bolus impaction in the upper gastrointestinal tract: an updated analysis in a European tertiary care hospital. Eur J Gastroenterol Hepatol, 2023, 35(9): 962-967.
10. Xu G, Chen YC, Chen J, et al. Management of oesophageal foreign bodies in children: a 10-year retrospective analysis from a tertiary care center. BMC Emerg Med, 2022, 22(1): 166.
11. Privato R, Pezzoli F, Barni S, et al. Esophageal food bolus impaction in children: a 15-year experience and a review. J Pediatr Gastroenterol Nutr, 2025, 80(1): 57-68.
12. Fung BM, Sweetser S, Wong Kee Song LM, et al. Foreign object ingestion and esophageal food impaction: an update and review on endoscopic management. World J Gastrointest Endosc, 2019, 11(3): 174-192.
13. Karb D, DeLozier S, Raad D, et al. Effect of delayed endoscopy protocol on timing and safety of endoscopy for foreign body ingestion and esophageal food impaction. J Clin Gastroenterol, 2023, 57(9): 890-894.
14. Kumar R, Soni N, Bhardwaj S, et al. Intentional foreign body ingestion. Intern Emerg Med, 2019, 14(8): 1331-1333.
15. Turgut K, Poyraz MK, Sekmen E, et al. Prevalence of attention deficit hyperactivity disorder (ADHD) in children presenting with foreign body ingestion. Am J Emerg Med, 2019, 37(12): 2121-2124.
16. Navia-López LA, Cadena-León JF, Ignorosa-Arellano KR, et al. Foreign body ingestion and associated factors in pediatric patients at a tertiary care center. Rev Gastroenterol Mex (Engl Ed), 2022, 87(1): 20-28.
17. Smetak MR, Wilcox LJ. Button-battery ingestion. N Engl J Med, 2024, 391(12): 1139.
18. Lorenzo C, Azevedo S, Lopes J, et al. Battery ingestion in children, an ongoing challenge: recent experience of a tertiary center. Front Pediatr, 2022, 10: 848092.
19. Nugud AA, Tzivinikos C, Assa A, et al. Pediatric magnet ingestion, diagnosis, management, and prevention: a European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) position paper. J Pediatr Gastroenterol Nutr, 2023, 76(4): 523-532.
20. Jin Y, Gao Z, Zhang Y, et al. Management of multiple magnetic foreign body ingestion in pediatric patients. BMC Pediatr, 2022, 22(1): 448.
21. Lu D, Lv L, Gu Q, et al. Extraction of fish bones embedded in the esophagus via endoscopic submucosal dissection: two case reports and literature review. Front Med (Lausanne), 2021, 8: 746720.
22. Díaz Granados A, Dabán López P, Jurado Prieto FJ, et al. Acute pancreatitis due to fishbone. Rev Esp Enferm Dig, 2024.
23. Xiao JB, Siu JM, Propst EJ, et al. Consumer trends reflected in the contents of the pediatric esophagus: a 20-year review. Laryngoscope, 2025, 135(1): 438-444.
24. Zhang M, Wan J, Zhou Q. Time trends and endoscopic management of foreign body ingestion in the upper GI tract: a retrospective analysis of 1, 152 cases in China. Revista Espanola De Enfermedades Digestivas, 2023, 115(9): 488-495.
25. He Z, Xu Q, Fan W, et al. Non-foreign body-associated risk factors for complications associated with esophageal foreign-body removal and timing of endoscopic treatment: a single-center retrospective study. BMC Gastroenterol, 2024, 24(1): 429.

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