High-Risk foreign body ingestion in children: clinical features and endoscopic outcomes

Objective To evaluate clinical features and endoscopic outcomes in children with high-risk upper gastrointestinal (GI) foreign bodies, stratified by object type. Methods We retrospectively reviewed cases of children who ingested high-risk foreign bodies with upper GI retention at a Chinese tertiary pediatric center (January 2020–December 2024). Patients were stratified by the type of ingested foreign body: sharp objects, magnetic objects, or button batteries. Demographics, symptoms, retention sites, injuries, complications, and outcomes were analyzed. Results Among 155 children, 61 (39.4%) ingested sharp objects, 42 (27.1%) magnetic objects, and 52 (33.5%) button batteries. All underwent attempted endoscopic retrieval. Groups differed significantly in age, retention site, and ingestion-to-presentation duration (all P < 0.05). Button battery ingestions occurred predominantly in children aged 0–3 years; sharp objects predominantly lodged in the esophagus, while magnets and button batteries were mainly retained in the stomach. Magnetic ingestions had the longest duration (>24 h) because they were often asymptomatic. Pain was more common with sharp and magnetic objects ( P < 0.05); vomiting and perforation rates were highest in the magnetic group ( P < 0.05), likely because only cases involving ≥2 magnets were included. Dysphagia was more frequent with sharp objects and batteries ( P < 0.05). Esophagogastroduodenoscopy (EGD) was first-line with a success rate of 96.1%; two sharp cases needed rigid esophagoscopy, and the magnetic group had higher surgical rates ( P < 0.05). Conclusion High-risk foreign body ingestion is dangerous, especially ingestion of multiple magnetic foreign bodies, which are associated with high perforation and surgical rates. EGD is effective first-line therapy. Urgent intervention is needed for multiple magnets (even asymptomatic) and delayed cases. Post-removal follow-up is important, and our comparative analysis guides risk-stratified management.