Which specialist can help if an object is dislodged in the oesophagus (esophagus) and the patient is having trouble?

Specialist Referral for Esophageal Foreign Body

A gastroenterologist should be the primary specialist consulted for an esophageal foreign body, as flexible endoscopy performed by a gastroenterologist is the first-line treatment approach with up to 90% success rates. 1

Multidisciplinary Team Approach

Management of esophageal foreign bodies requires coordination among multiple specialists depending on the clinical scenario 1:

Primary Specialists:

• Gastroenterologists: Perform flexible endoscopy, which is the gold standard first-line intervention for most esophageal foreign bodies 1
• Emergency physicians: Initial assessment, stabilization, and coordination of urgent/emergent endoscopy 1

Secondary/Backup Specialists:

• Otorhinolaryngologists (ENT surgeons): Perform rigid endoscopy for upper esophageal foreign bodies when flexible endoscopy fails or is unsuitable 1
• Thoracic surgeons: Required for surgical intervention if endoscopic removal fails, perforation occurs, or the foreign body is irretrievable 1
• General surgeons: Manage complications such as perforation with extensive contamination, mediastinitis, or pleural empyema 1

Timing and Urgency

The urgency determines which specialist should be contacted first 2, 3:

Emergent (within 2-6 hours) - Contact gastroenterology immediately:

• Complete esophageal obstruction with drooling or inability to swallow saliva 2, 3
• Sharp-pointed objects in the esophagus 3
• Button batteries in the esophagus 1

Urgent (within 24 hours) - Contact gastroenterology during business hours:

• Esophageal foreign bodies without complete obstruction 2, 3
• Food bolus impaction causing symptoms but not complete obstruction 4

When to Involve Other Specialists

ENT/Otorhinolaryngology consultation indicated when:

• Foreign body is located in the upper esophagus (hypopharynx or upper esophageal sphincter), which is the "Achilles' heel" of flexible endoscopy 1
• Concomitant respiratory symptoms or suspicion of airway foreign body 1
• Flexible endoscopy has failed 1

Surgical consultation (thoracic or general surgery) indicated when:

• Irretrievable foreign body after endoscopic attempts 1
• Confirmed or suspected esophageal perforation 1
• Foreign body close to vital structures like the aortic arch 1
• Complications such as mediastinitis, pleural empyema, or severe bleeding 1
• Extensive pleural or mediastinal contamination requiring immediate surgery 1

Common Pitfalls to Avoid

• Do not delay endoscopy by attempting prolonged observation or pharmacologic interventions, as this increases aspiration risk and complications 2, 4
• Do not order barium swallow studies, as they increase aspiration risk and impair endoscopic visualization 4, 3
• Do not assume radiographs rule out foreign bodies - plain films have up to 85% false-negative rates for non-radiopaque objects, so proceed with endoscopy based on clinical symptoms 2, 4
• Ensure airway protection - endotracheal intubation should be considered for high aspiration risk cases 3

Key Clinical Algorithm

1. Initial contact: Emergency physician or primary care physician stabilizes patient
2. Immediate gastroenterology consultation for flexible endoscopy (first-line) 1
3. If flexible endoscopy fails or upper esophageal location: ENT consultation for rigid endoscopy 1
4. If endoscopic removal fails or complications occur: Surgical consultation (thoracic or general surgery) 1