Endoscope selection method for removing foreign body

Abstract

Provided is an endoscope selection method for removing a foreign body, the endoscope selection method comprising the steps of: extracting data information about a type of foreign body, age, weight, and a sedation method; and adjusting an endoscope device and a removal procedure period on the basis of the extracted information.

Description

How to Choose an Endoscope for Foreign Body Removal

[0001] The present invention relates to a novel method for selecting an endoscope for removing foreign bodies.

[0002] Ingestion of an upper gastrointestinal (UGI) foreign body (FB) is the most common indication for therapeutic upper gastrointestinal endoscopy in children. It occurs most frequently in children between 6 months and 3 years of age, with coins being the most common foreign body, accounting for up to 69% of ingested foreign bodies.

[0003] Among cases of FB ingestion requiring medical treatment, 80-90% resolve spontaneously, 10-20% require endoscopic removal, and less than 1% ultimately require surgery. Flexible endoscopy has a greater than 95% success rate in removing UGI FB.

[0004] Endoscopic techniques and equipment have advanced tremendously, making it increasingly common practice for pediatric endoscopists to remove FBs (more easily) without waiting for spontaneous passage.

[0005] The timing and need for endoscopic FB removal in children are determined by three main factors: the type of FB ingested, its location, and the patient's symptoms. Large, sharp, or rapidly damaging objects, such as multiple magnets or disk batteries, require rapid removal. However, even for smaller FBs, if they remain in one location for a long time or are not expected to pass spontaneously, endoscopic removal may be necessary at an appropriate time. If endoscopic removal is not possible due to the type, size, location, or complications of the FB, surgical removal should be considered.

[0006] In children, if endoscopic removal is possible, there are several factors to consider before performing it. This is because the type of FB ingested, age, weight, and sedation method used in children are significantly different from those in adults. This procedure must be performed quickly and safely by a skilled pediatric endoscopist. Therefore, selecting the appropriate endoscopic assist device is crucial for rapid and safe FB removal. Some assist devices are available with health insurance coverage.

[0007] Previous studies on FBs in the pediatric UGI tract have focused on FB type, the age of patients receiving FBs, and management (surgical versus endoscopic removal). Few studies have examined device selection and the duration of endoscopic removal procedures, highlighting the ongoing need for technological advancement.

[0008] Therefore, this study was conducted to describe the overall experience of pediatric endoscopic UGI FB removal in a real-world clinical setting, based on the experiences of four university hospitals actively performing pediatric gastrointestinal endoscopy. Data analysis focused on endoscopic techniques, including sedation type, duration of endoscopic procedure, and accessories used for endoscopic removal under conscious conditions.

[0009] According to one embodiment of the present invention, an endoscopic selection method for foreign body removal is provided, comprising: a step of extracting data information on the type, age, weight, and sedation method of a foreign body; and a step of adjusting an endoscopic device and a removal procedure period according to the extracted information.

[0010] According to one embodiment of the present invention, the endoscopic device may be at least one of forceps and a mesh.

[0011] According to one embodiment of the present invention, the step of extracting the data information may further include data regarding consciousness.

[0012] According to one embodiment of the present invention, the type of the foreign substance may be at least one of a coin, a disk blade, a Go stone, and a magnet.

[0013] According to one embodiment of the present invention, the step of extracting the data information may further include data regarding the location of the foreign substance.

[0014] According to one embodiment of the present invention, the location of the foreign body may be at least one of the esophagus and the stomach.

[0015] According to one embodiment of the present invention, there is an advantage in that an endoscopic device and a procedure period for efficient removal of a foreign body can be selected by including a step of extracting data information on the type, age, weight, and sedation method of a foreign body; and a step of adjusting an endoscopic device and a procedure period according to the extracted information.

[0016] Figure 1 shows the duration of endoscopic FB removal procedures according to the location of the FB and the device used when both tools are clinically available, showing that (A) the underweight group (<14.9 kg, n = 188) had a significantly shorter procedure time for gastric FB retrieval using a search net than for gastric and esophageal FBs retrieval using forceps (P = 0.005, P = 0.008, respectively), and (B) the heavier group (≥14.9 kg, n = 183) had a shorter procedure time for retrieval using a search net than for retrieval using forceps (P = 0.026).

[0017] Figure 2 illustrates endoscopic foreign body removal using a search net (A) and forceps (B), showing that Rosnet is the most successful because there is little chance of FBI escaping.

[0018] In accordance with the best form of the present invention, an endoscopic selection method for removing a foreign body is provided, comprising: a step of extracting data information on the type, age, weight, and sedation method of a foreign body; and a step of adjusting an endoscopic device and a removal procedure period according to the extracted information.

[0019] Hereinafter, the present invention will be described in detail. Prior to this, the terms or words used in this specification and claims should not be interpreted as limited to their conventional or dictionary meanings. Rather, they should be interpreted with meanings and concepts that conform to the technical concept of the present invention, based on the principle that the inventor can appropriately define the concept of the term to best explain his or her invention. Therefore, the configurations described in the embodiments described in this specification are merely the most preferred embodiments of the present invention and do not represent the entire technical concept of the present invention. Therefore, it should be understood that various equivalents and modified examples may exist as of the time of filing this application.

[0020] According to one embodiment of the present invention, an endoscopic selection method for foreign body removal is provided, comprising: a step of extracting data information on the type, age, weight, and sedation method of a foreign body; and a step of adjusting an endoscopic device and a removal procedure period according to the extracted information.

[0021] Ingestion of foreign bodies (FBs) is the most common indication for therapeutic endoscopy in infants. Depending on the type of FB, the child's age, and its location, endoscopic removal may be necessary. Therefore, the inventors of this study aimed to analyze the characteristics of each device used for endoscopic FB removal in children.

[0022] Additionally, medical records regarding patient age, sex, weight, type, location, size, shape, type of device used for endoscopic removal, and time of endoscopic procedure were collected retrospectively.

[0023] A total of 424 FB ​​removal procedures were analyzed. The mean age of patients at the time of FB removal was 4.1±3.7 years. Coins were the most common FB (192, 45.3%). The most common locations for FB removal were the esophagus (45.7%) and stomach (48.3%), respectively. Forceps were used in 96 of the 371 cases (25.9%).

[0024] Among a total of 371 cases, forceps were used in 96 cases (25.9%) for esophageal FB and 25 cases (6.7%) for gastric FB, and mesh was used in 250 cases (67.4%) for gastric FB retrieval. The mean procedure durations were 7.2 ± 7.4 minutes, 8.5 ± 7.2 minutes, and 5.7 ± 7.3 minutes, respectively (P = 0.003).

[0025] Additionally, in the underweight patient group, the procedure time was significantly shorter when mesh was used than when forceps was used for gastric FB removal (P = 0.001).

[0026] That is, the duration of endoscopic procedures in low-birth-weight children was shorter when a retrieval mesh was used than when forceps was used.

[0027] Ingestion of an upper gastrointestinal (UGI) foreign body (FB) is the most common indication for therapeutic upper gastrointestinal endoscopy in children. It occurs most frequently in children between 6 months and 3 years of age, with coins being the most common foreign body, accounting for up to 69% of ingested foreign bodies.

[0028] Among cases of FB ingestion requiring medical treatment, 80-90% resolve spontaneously, 10-20% require endoscopic removal, and less than 1% ultimately require surgery. Flexible endoscopy has a greater than 95% success rate in removing UGI FB.

[0029] Endoscopic techniques and equipment have advanced tremendously, making it increasingly common practice for pediatric endoscopists to remove FBs (more easily) without waiting for spontaneous passage.

[0030] The timing and need for endoscopic FB removal in children are determined by three main factors: the type of FB ingested, its location, and the patient's symptoms. Large, sharp, or rapidly damaging objects, such as multiple magnets or disk batteries, require rapid removal. However, even for smaller FBs, if they remain in one location for a long time or are not expected to pass spontaneously, endoscopic removal may be necessary at an appropriate time. If endoscopic removal is not possible due to the type, size, location, or complications of the FB, surgical removal should be considered.

[0031] In children, if endoscopic removal is possible, there are several factors to consider before performing it. This is because the type of FB ingested, age, weight, and sedation method used in children are significantly different from those in adults. This procedure must be performed quickly and safely by a skilled pediatric endoscopist. Therefore, selecting the appropriate endoscopic assist device is crucial for rapid and safe FB removal. Some assist devices are available with health insurance coverage.

[0032] Previous studies of FBs in the UGI tract in children have focused on FB type, age of patients receiving FBs, and management type (surgical versus endoscopic removal). Few studies have examined device selection and duration of endoscopic removal procedures.

[0033] Therefore, this study was conducted to describe the overall experience of pediatric endoscopic UGI FB removal in a real-world clinical setting, based on the experiences of four university hospitals actively performing pediatric gastrointestinal endoscopy. Data analysis focused on endoscopic techniques, including sedation type, duration of endoscopic procedure, and accessories used for endoscopic removal under conscious conditions.

[0034]

[0035] The present invention will be described in more detail based on the following examples. However, the following examples are merely illustrative examples for further explaining the present invention, and the present invention is not limited to the following examples.

[0036]

[0037] Experimental method

[0038] We retrospectively analyzed the medical records of pediatric patients under 18 years of age who underwent UGI endoscopic FB removal at four university hospitals from January 2012 to August 2020 (Chungbuk National University Hospital, CNUH; Gangneung Asan Medical Center, GAH; Pusan ​​National University Yangsan Hospital, PNUYH; Jinju Gyeongsang National University Hospital, GNUH).

[0039] This procedure was performed by seven pediatric endoscopists. Patients diagnosed with gastric FB ingestion who did not meet the indications for endoscopic removal were excluded from the study. Patients in whom endoscopic removal attempts failed due to spontaneous passage were also excluded from the study.

[0040] Demographic data, including age, sex, and weight (kg), were collected. Patients were categorized into age groups: less than 1 year, 1 to 5 years, 6 to 10 years, and 11 to 18 years. Information on the type of FB, initial FB location (at diagnosis), and FB location at the time of removal were recorded. Because the normal minimum body weight for 5-year-old boys in Korea is 14.9 kg (<14.9 kg) and 14.9 kg (>14.9 kg), the subjects were divided into two groups based on a weight of 14.9 kg.

[0041] Based on endoscopic data, sedation methods, endoscopic procedure time (minutes), and complications were investigated. Endoscopic procedure time was recorded in the electronic medical record (EMR), including the start and end times of the endoscopic procedure and the calculated time. The types of accessory devices used to retrieve the FB (e.g., forceps, retrieval mesh, snare, etc.) were also reviewed.

[0042] We conducted additional analyses focusing on the type of device used. We analyzed the duration of the procedure based on the location of the FB and the device, selecting cases where both forceps and retrieval nets could be used, based on the type and shape of the FB. This analysis excluded FBs located above or below the esophagus, as well as cases where a retrieval net was used in the esophagus. Cases where multiple devices were used or multiple FBs were present (in multiple organs) were also excluded.

[0043] Statistical analyses were performed using the frequency and analysis of variance tests in SAS Statistical Analysis Software (version 9.4; SAS Institute, Inc., NC, USA). Statistically significant differences were reported when the P value was less than 0.05.

[0044]

[0045] Ethics Statement

[0046] The study protocol was approved by the Institutional Review Boards of GNUH (2020-10-002), CNUH (2022-04-017), GAH (2020-12-011), and PNUYH (05-2020-210). Because this was a retrospective study using medical records, the requirement for informed consent from individual participants was waived.

[0047]

[0048] result

[0049] Patient characteristics

[0050] A total of 424 children aged 6 months to 18 years underwent UGI endoscopic FB removal during the study period (Table 1). The patients included 265 (62.5%) from the PNUYH, 76 (17.9%) from the CNUH, 52 (12.3%) from the GNUH, and 31 (7.3%) from the GAH. The patients included 277 (65.3%) males and 147 (34.7%) females. The mean age of the patients was 4.1 ± 3.7 years; 65 (15.3%) were younger than 1 year of age, and 304 (71.7%) were younger than 5 years of age. The mean body weight was 18.3 ± 11.9 kg (median: 14.9 kg).

[0051] A total of 394 procedures (92.9%) were performed under conscious sedation (Table 1). Midazolam was used in 391 procedures (92.2%), and 339 endoscopies (80.0%) were performed under conscious sedation using midazolam and ketamine. Thirty-five patients (8.3%) were sedated with midazolam, and 20 procedures were performed using propofol with or without midazolam.

[0052] SedationNo sedation30 (7.1)Midazolam only35 (8.3)Midazolam + Ketamine339 (80.0)Midazolam + Profofol17 (4.0)Profofol only3 (0.7)Type of FBsCoins192 (45.3)Disc battery73 (17.2)Marble / Baduk stone28 (6.6)Magnet26 (6.1)Bone / Fishbone / Shell22 (5.2)Others83 (19.6)Used device for removing FBsForceps136 (32.1)Net279 (65.8)Snare8 (1.9)Others1 (0.2)

[0053] Table 1 presents demographic data, conscious sedation method, type of FB, and endoscopic device used in children who underwent endoscopic FB removal. Values ​​are presented as mean ± standard deviation, number (%), or median (range), FB = foreign body.

[0054] ParametersInitial siteRemoval siteAryepiglottic fold8 (1.9)8 (1.9)Esophagus194 (45.8)108 (25.5)UES163 (38.4)78 (18.4)Middle14 (3.3)22 (5.2)LES17 (4.0)8 (1.9)Stomach205 (48.3)294 (69.5)Duodenum16 (3.8)13 (3.1)Multiple site (stomach, duodenum)1 (0.2)Total424 (100)423 (100)

[0055] Table 2 shows the location of foreign bodies during endoscopy, with values ​​expressed as numbers (%), UES = upper esophageal sphincter, LES = lower esophageal sphincter.

[0056] Age group, yrCoinDisc batteryMarble / Baduk stoneMagnetBone / Fishbone / ShellOthersProcedure duration, min≤1 (n=65)12 (18.5)26 (40.0)3 (4.6)4 (6.2)020 (30.8)5.2 ± 6.615 (n=39)125 (52.3)42 (17.6)16 (6.7)15 (6.3)7 (2.9)34 (14.2)6.3 ± 7.1610 (n=9)52 (58.4)5 (5.6)9 (10.1)7 (7.9)4 (4.5)12 (13.57.0 ± 8.11118 (n=1)3 (9.7)0 (0)0 (0)0 (0)11 (35.5)17 (54.88.7 ± 8.4

[0057] Table 3 shows the proportion of foreign bodies identified in different age groups and the duration of treatment. Values ​​are expressed as mean ± standard deviation, FB = foreign body.

[0058]

[0059] Endoscopic FB removal procedure

[0060] The most commonly used device (for endoscopic FB removal in children) was the endoscopic FB net (65.8%), followed by forceps (32.1%). The endoscopic FB net was the most commonly used device in children under 10 years of age, while forceps (51.6%) were the most commonly used device in children 10 years of age and older (Table 4). There were no significant differences in the devices used across institutions.

[0061] The mean duration of the FB removal procedure was 6.5 ± 7.3 minutes. The mean durations in the <1 year, 1-5 years, 6-10 years, and 11-18 years groups were 5.2 ± 6.6, 6.3 ± 7.1, 7.0 ± 8.1, and 8.7 ± 8.4 minutes, respectively (the difference was not statistically significant, P = 0.154). Two hundred and seventy-three (64.4%) procedures were performed within 5 minutes.

[0062] Both forceps and mesh were used in 371 cases. The endoscopic removal time for gastric FBs using mesh was the shortest (5.7 ± 7.3 minutes, P = 0.003) (Table 5). Post hoc analysis showed that mesh use for gastric FBs was significantly shorter than forceps use for esophageal or gastric FBs (P = 0.011 and P = 0.008, respectively).

[0063] This difference was more significant in the group of patients weighing less than 14.9 kg (n = 188, P = 0.007). However, no significant difference was found in the replacement group (≥ 14.9 kg) (n = 183, P = 0.075) (Figure 1). In the low-body weight group, the duration of gastric FB retrieval using mesh was significantly shorter than that of gastric and esophageal FB retrieval using forceps (P = 0.004) (Figure 1). In the high-body weight group, the duration of the procedure for retrieving a gastric FB using a retrieval mesh was also shorter than that for a FB in the same location using forceps (P = 0.026), but did not differ from the time taken to retrieve an esophageal FB using forceps (P = 0.075) (Figure 1).

[0064] When multivariate analysis was performed on the type of device used and the shape and maximum diameter of the FB, the duration of the procedure was significantly shorter in the group weighing less than 14.9 kg when a recovery mesh was used (P = 0.047).

[0065] There were no reported complications associated with the FB removal procedure except in one patient.

[0066] Age group, yrForcepsRetrieval netSnareOthers1 (n = 65)15 (23.1)49 (75.4)1 (1.5)15 (n = 39)71 (29.7)167 (69.9)1 (0.4)6-10 (n = 9)34 (38.2)53 (59.6)1 (1.1)1 (1.1)11-18 (n =1)16 (51.6)10 (32.3)5 (16.1)Total (n = 424)136 (32.1)279 (65.8)8 (1.89)1 (0.24)

[0067] Table 4 shows the proportion of foreign body search procedures performed using different devices by age group, with values ​​expressed as numbers (%).

[0068] Location of FB removedDeviceDuration of the endoscopic FB removal procedure, minTotal (n = 371)Less than 14.9 kg (n = 188)More than 14.9 kg (n = 183)EsophagusForceps7.2 ±7.4(n=96)8.4 ±± 7.1 (n = 39)6.3 ​​± 7.5 (n = 57)StomachForceps8.5 ± 7.2 (n = 25)7.1 ± 6.4 (n = 12)9.7 ± 7.9 (n = 13)Retrieval net5.7 ± 7.3 (n = 250)5.2 ± 7.0 (n = 137)6.2 ± 7.5 (n = 112)P value0.0030.0010.06

[0069] Table 5 Duration of endoscopic retrieval procedures by location and device when both tools were clinically available (n = 371); values ​​are expressed as mean ± standard deviation, FB = foreign body.

[0070]

[0071] As described above, although the present invention has been described with reference to preferred manufacturing examples, examples, comparative examples and test examples, it will be understood by those skilled in the art that the present invention can be variously modified and changed within the scope and spirit of the present invention as set forth in the following claims.

Claims

1. A step of extracting data information on the type, age, weight and sedation method of the foreign body; and A method for selecting an endoscope for foreign body removal, comprising: a step of adjusting an endoscopic device and a removal procedure period according to the extracted information; 2. In paragraph 1, A method for selecting an endoscope for removing a foreign body, wherein the endoscopic device is at least one of forceps and a mesh.

3. In paragraph 1, A method for selecting an endoscope for removing a foreign body, wherein the step of extracting the above data information further includes data regarding consciousness.

4. In paragraph 1, A method for selecting an endoscopic method for removing a foreign body, wherein the type of the foreign body is at least one of a coin, a disc bead, a go stone, and a magnet.

5. In paragraph 1, A method for selecting an endoscope for removing a foreign body, wherein the step of extracting the above data information further includes data regarding the location of the foreign body.

6. In paragraph 5, A method of selecting an endoscopic method for removing a foreign body, wherein the location of the foreign body is at least one of the esophagus and the stomach.

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