P0687 - Clinical Features and Endoscopic Management of Sharp Wooden Object Ingestions: A Systematic Review of 479 Cases

Benjamin Chipkin, MD, MS¹, Kay Chen, MD², Alyssa A. Grimshaw, MSLIS, MBA, MPH³, Fateh Bazerbachi, MD⁴, Darrick Li, MD, PhD^5
1Yale School of Medicine, New Haven, CT; ²University of California San Diego School of Medicine, La Jolla, CA; ³Yale University, New Haven, CT; ⁴CentraCare St Cloud Hospital, St. Cloud, MN; ⁵Yale School of Medicine / Connecticut GI, New London, CT

Introduction: Ingested sharp wooden objects pose increased risks compared to other foreign bodies. Management remains varied, with debate surrounding optimal use of conservative observation, endoscopic retrieval, or surgical removal. We conducted the largest systematic review to date of sharp wooden object ingestions to elucidate patterns in clinical presentation and guide management practices.

Methods: The systematic review was conducted according to a published protocol on the PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Synthesis Without Meta-analysis (SWiM) reporting guidelines. Cochrane Library, Google Scholar, Ovid MEDLINE, Ovid Embase, PubMed, Scopus, and Web of Science Core Collection databases were searched for case reports and series of adults age ≥18 years who ingested sharp wooden objects. Descriptive statistics were reported for risk factors, clinical presentations, laboratory and imaging findings, adverse events, and treatments.

Results: Analysis of 479 cases from 413 studies showed that most were unaware of ingestion (74.8%) and toothpicks were the most commonly ingested item (92.5%), followed by skewers (2.3%) and chopsticks (2.1%). Risk factors included male sex (70.1%), substance use (9.4%), and edentulousness (6.1%) (Table 1). Common symptoms were abdominal pain (83.7%), vomiting (17.1%), and nausea (13.8%). Common signs were fevers (36.7%), tachycardia (14.2%), and hypotension (9.4%). Imaging identified objects in 48.1% of cases, with CT being most sensitive (54.7%). Objects were commonly found in the gastrointestinal tract (79.3%) and liver (11.9%). Endoscopy visualized objects 76.1% of the time, with successful removal in 88.8% of those cases. 4.7% of patients required surgery following endoscopic removal. Endoscopy was more common when ingestion was known (20.4% vs 10.7%, p=0.01) or imaging showed intra- or transluminal objects (79.6% vs 56.8%, p< 0.001). Antibiotic administration was reported in 45.9%. Adverse events included perforation (87.5%), abscess (33.0%), GI bleeding (10.0%), bacteremia (8.4%), pseudotumor (4.8%), and fistula (4.4%), with a mortality rate of 5.0%.

Discussion: Sharp wooden object ingestion presents heterogeneously and can lead to serious complications. Endoscopic removal is safe and effective. We propose a clinical management algorithm in Figure 1.



Disclosures:


Benjamin Chipkin, MD, MS¹, Kay Chen, MD², Alyssa A. Grimshaw, MSLIS, MBA, MPH³, Fateh Bazerbachi, MD⁴, Darrick Li, MD, PhD⁵. P0687 - Clinical Features and Endoscopic Management of Sharp Wooden Object Ingestions: A Systematic Review of 479 Cases, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.