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Gastrointestinal Endoscopy - part 4

Rủi ro: thủng thực quản, nhưng báo cáo gần đây của phòng cấp cứu sử dụng cho các bệnh nhân nhi khoa cho thấy nguy cơ tối thiểu • Đẩy mạnh trục xuất - Sử dụng emetics - Rủi ro: không kiểm soát được, có thể gây ra vỡ, thủng | 70 Gastrointestinal Endoscopy Table 9.2. Iatrogenic foreign bodies - Gastrostomy tubes - Biliary stents - Sucralfate - Dental drills - Esophageal stents - Impacted Dormia baskets - Surgical gauze - Cyanoacrylate concretions Table 9.3. Bezoars Phytobezoar Vegetable material Diospyrobezoar Persimmon berries Trichobezoar Hair Lactobezoar Milk 9 - Blind passage of bougie Hurst blunt tip dilator - Risk esophageal perforation but recent report of emergency room use for pediatric patients suggests minimal risk Promote expulsion - Use of emetics - Risks uncontrolled could cause rupture perforation or aspiration - Extraction with foley balloon catheter under fluoroscopic guidance inflate with contrast large case series with high success rate 92 of229 cases Criteria blunt objects in place 12 hours. Risk aspiration or tracheal obstruction if object falls into hyopharynx and have McGill forceps and laryngeoscope available. Some argue only use if endoscopy not available. Options for Removal Endoscopic General Cooperative or well sedated patient required to maximize safety. In children general anesthesia and endotracheal intubation often needed Always visualize path of endoscope. It may be risky to attempt blind intubation of esophagus in this setting if hypopharyngeal object present Consider practice with an object similar to the one ingested to facilitate the procedure If repeated intubation required consider overtube use Once object removed esophagus may be dilated if stricture present and minimal inflammation Narcotic-filled condoms or wrapped in plastic should not be removed endoscopically due to risk of rupture Gastrointestinal Foreign Bodies 71 Table 9.4. Endoscopic accessories for foreign body removal Rattooth forcep Two channel therapeutic scope Alligator forcep Banding overtube Tripod Enteroscope gastric overtube Snares Endoscopic suture scissors Roth retrieval net Latex hood or bell Bipolar snare Band ligator TTS balloons Dormia basket Table 9.5. Sedation guidelines .