University of Santo Tomas, Faculty of Medicine and Surgery Manila, National Capital Region, Philippines
Maria-Kassandra E. Coronel, MD1, Vicente I. Martires, MD2, Stephanie L. Lee, MD1 1University of Santo Tomas, Faculty of Medicine and Surgery, Manila, National Capital Region, Philippines; 2University of Santo Tomas Faculty of Medicine and Surgery, Manila, National Capital Region, Philippines
Introduction: Intentional Foreign Body Ingestion (IFBI) has been thoroughly discussed in the fields of pediatrics, emergency medicine and surgery, but lacks comprehensive discussion with regard to its relation to substance abuse disorder (SAD) as a psychiatric illness. This study aims to evaluate the relation of IFBI among adults with SAD and outcomes of endoscopic treatment.
Methods: A methodical review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed utilizing electronic databases (Medline/PubMed, Google scholar, Cochrane, Scopus database), MeSH terms and Boolean logic to identify relevant peer-reviewed articles published between January 1, 2015 to June 1, 2021. This study included cases reporting endoscopic findings of IFBI among adults (aged 18 years and older), and excluded those that did not mention the number and type of items deliberately ingested. Eligible studies were limited to the English language and evaluated using the Joanna Briggs Institute (JBI) critical appraisal tool.
Results: Of the 55 studies included in this review, 2 cases reported IFBI among patients with SAD. The average age of non-SAD patients was less than patients with SAD (34.40 vs. 46.50 years, p=0.124). The most common presentation for SAD patients was bloody stools (n=2, 100%), while for non-SAD patients, the most common presentation was abdominal pain (n=24, 46%). The most common foreign bodies ingested in SAD patients were sharps/blades (n=2, 100%) followed by large plastic >3cm in size (n=1, 50%); whereas for non-SAD patients, the most common were small metal < 3cm in size (n=147, 26.34%) and sharps/blades (n=126, 22.58%). A higher average of reports of interdisciplinary referrals (μ=0.849 vs. 0.50, p=0.197) and number of referrals made per patient (μ=1.37 vs. 0.50, p=0.219) was found in non-SAD, compared to SAD patients. Overall, patients with SAD reported a lesser mean number of successful endoscopic retrieval (μ=0 vs. 0.72, p< 0.05), and a greater mean number of surgical procedures performed post-endoscopic FB retrieval failure (μ=2.5 vs. 0.47, p< 0.01), than those without the SAD.
Discussion: IFBI cases of patients with SAD have relatively lower endoscopic treatment success rates and are likely to have additional invasive procedures performed compared to non-SAD patients. Further research on appropriate treatment guidelines are needed to prevent complications and recurrence in these subset of SAD patients.
Maria-Kassandra Coronel indicated no relevant financial relationships.
Vicente Martires indicated no relevant financial relationships.
Stephanie Lee indicated no relevant financial relationships.
Maria-Kassandra E. Coronel, MD1, Vicente I. Martires, MD2, Stephanie L. Lee, MD1. P2494 - Substance Abuse Disorder and Intentional Foreign Body Ingestion: A Review of Implications for Endoscopic Outcomes, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.