An Outcome Study on the Management of Alleged Fish Bone Ingestion Using Fibre-Optic Endoscope by Emergency Physician

Background Patient with alleged fish bone ingestion with negative oropharyngeal examination requires an upper gastrointestinal (GI) endoscopy for definitive care. Aim To study the competency and cost-effectiveness in patients with alleged fish bone ingestion using fibre-optic endoscope by emergency physician. Method A retrospective study in patients with endoscopy for alleged fish bone ingestion for a period of six months from January to June 2001. A telephone survey was conducted specifically asking for post-endoscopy or fish bone ingestion related complications. Results Ninety-six patients were recruited in the study. There were 42 males and 54 females with a ratio of 1:1.3. The detection rate was 32%. Eighty-seven percent of the fish bones was retrieved, and 13% was dislodged. Over 90% of fish bones were found in oropharynx and laryngopharynx. In the telephone survey, 81 patients (84.4%) could be contacted by phone and they experienced uneventful outcome after endoscopy. Of those who could not be contacted, there was no documented attendance or admission in any other hospital (under Hospital Authority) according to the computer records in Clinical Management System. Ninety-six hospital bed-days, which were equal to $350,400, could be saved under our approach in alleged fish bone ingestion without admitting patients into surgical unit for treatment. Conclusion Emergency physician was competent enough in performing upper GI endoscopy, and this method of managing alleged fish bone ingestion was shown to be safe and cost saving.