S682 Esophageal Foreign Body Impaction Followed by Immediate Dilation Is Not Associated With an Increased Risk of Esophageal Perforation: A Systematic Review With Meta-Analysis
Bibliographic record
Abstract
Introduction: Esophageal foreign body impaction requires urgent endoscopic evaluation for removal of the impacted foreign body. Its incidence is associated with esophageal pathology, including esophageal strictures and rings. Practice regarding performing immediate esophageal dilation during the index endoscopy is variable. Established guidelines indicate that, in most circumstances, it is safe to perform immediate esophageal dilation after foreign body impaction, which is based on limited observational trials. Given the scant evidence for this suggestion, our aim was to determine if immediate esophageal dilation in the same session as foreign body extraction is associated with esophageal perforation. Methods: We performed a systematic search of PubMed. Inclusion criteria were adult patients undergoing endoscopy for evaluation of esophageal foreign body impaction with immediate dilation with the comparator of no immediate dilation. Our primary outcome was esophageal perforation. Methodological quality was assessed with the Newcastle-Ottawa Scale. Meta-analysis with random-effects model was performed. Results: The search identified 1087 unique citations of which 6 observational cohort studies and 1 case-control study met our inclusion criteria. There were no perforation events in any patient undergoing immediate dilation in the included studies. Of the 3 cohort studies with estimable effect size, there was no association between immediate dilation and esophageal perforation: RR = 3.68 (95% CI 0.68 – 19.94) without substantial heterogeneity (I2 = 0%). All included studies had methodological limitations. Conclusion: Immediate esophageal dilation after esophageal foreign body disimpaction was not associated with an increased risk of esophageal perforation in our systematic review and meta-analysis (see Figure 1).Figure 1.: Forest plot of esophageal perforation in included observational trials.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.013 | 0.003 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".