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MDT Excels in Extracting Foreign Bodies in Digestive Tract
CopyFrom: PUMCH UpdateTime: 2018-04-16 Hits: 13 Font Size: SmallBig

The Department of Gastroenterology, PUMCH, set dedicated staff to speed up the treatment of patients with foreign bodies in digestive tract. The average time from emergency to gastrointestinal endoscopy is shortened to 5.2 hours, with a successful extracting rate of 88.3% at emergency. The rate of difficult foreign bodies is 39.6%, and through a Multiple Disciplinary Team (MDT) we achieved a recovery and discharge rate of 97%.


Foreign bodies in digestive tract may damage the mucus and, in serious cases, cause perforation and threaten patient’s life. Early extraction can lower the risks effectively. Our hospital has seen in recent years an increase in patients and in the past three years performed 140 endoscopic extractions, 39.6% of which involving difficult foreign bodies. The hospital took effective measures and set staff aside at the Department of Gastroenterology for 24h duty all year round. Doctors experienced in endoscopy worked in shifts and dedicated nurses were appointed. After an assessment at emergency, suitable patients had a green channel to endoscopy. The improved system resulted in higher speed and efficacy. By 2016, the average response time had been cut from 7.0 hours in 2014 to 5.2 hours, with a successful extraction rate of 88.3%, higher than the average of 80.2% in medical literature.


Among the 140 extraction cases, 32% were referred to PUMCH from another hospital, of which 44% were extraction failures, and 11.7% were suspected of digestive tract perforation. This added to the difficulty and risks. Our MDT played an important role and was applied on 22% of the cases. Departments involved included gastroenterology, emergency, thoracic surgery, ENT, anesthesiology, radiology, vascular surgery, general surgery, ICU and MICU. In all respects MDT provided support: assessing the location and condition of foreign bodies, formulating anesthesia plan, emergency response during surgery and post-surgery treatment. In case of endoscopic extraction failure at emergency, ENT and general surgery would follow. Under the joint efforts the recovery and discharge rate reached 97%, and recovery of referred cases surpassed 95%.


According to Wang Qiang from Gastroenterology, MDT played a strong role in the extraction of digestive tract foreign bodies. They once had a patient with a fish bone in digestive tract, who was in five hospitals during three months. Upon arrival at PUMCH the fish bone was already in thoracic aorta adventitia. Our hospital finally extracted the fish bone and saved life by using thoracic endovascular aortic exclusion, gastroscopic extracting, coated stent-graft implantation, video-assisted right pleural adhesion lysis and drainage of the mediastinum.


Gastroenterology also tried to improve its tools. Foreign bodies in digestive tract are of various kinds and shapes, including animal bones, fruit cores, artificial teeth, food and metal objects, glass and lighters. Innovations were made on gastroscope accessories. A disposable cap with adjustable diameter was invented, which was softly attached to the front part of gastroscope to wrap up a foreign body captured, and therefore reduce secondary damage at the narrow section of digestive tract. The invention is now patented, whose application will facilitate operations.