Management of oesophageal foreign bodies

AbstractObjectiveThe aim of the study was to evaluate the management of foreign bodies in the oesophagus and to determine the association with socioeconomic status.MethodsThis cross-sectional analytical study was carried out in the Department of Ear, Nose and Throat and head and neck surgery of Bahawal Victoria Hospital affiliated with Quaid-i-Azam Medical College, Bahawalpur, Pakistan, between December 2012 and May 2013. The medical records of 34 consecutive cases of foreign body ingestion were searched, and the data were recorded on a questionnaire prepared for this purpose.ResultsThe average age of the patients was 10.38 years; 29 cases (85.2%) were in children under 12 years. There were 18 females (52.9%) and 16 males (47.1%). Thirty patients (88%) presented with a history of dysphagia, and 25 (73.6%) had vomiting. The site of impaction was the post-cricoid region in 22 patients (66%), the lower oesophagus in 5 (15%), the mid-oesophagus in 4 (13%), the posterior pharyngeal wall in 1 (3%) and the pyriform fossa in 1 patient (3%). Coins were the most common foreign body (61.8%). Socioeconomic analysis showed that 18 patients (52.9%) were in the low socioeconomic class, 12 (35.3%) in the middle class and 4 (11.8%) in the upper class.ConclusionThe presence of a foreign body in the oesophagus is a serious condition, and early removal is recommended. Foreign body lodgement is commoner among poor families

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)