[Repetitive intentional foreign body ingestion: Risk of abuse of propofol in endoscopic procedures].

Abstract

Background: Intentional foreign body ingestion (iFBI) represents an increasingly relevant clinical challenge that remains insufficiently evidence based in terms of treatment. Existing somatic (gastroenterologic) and psychiatric care structures may contribute to the maintenance of this behavior.

Objective: The aim of the present study is to highlight an aspect of the treatment of iFBI that has received little attention to date: the potential risk of misuse and dependence associated with propofol in the context of repeated endoscopic interventions. Our goal is to raise awareness that for vulnerable patient groups with iFBI such as individuals with borderline personality disorder (BPD), propofol should be considered not only as an anesthetic agent but also as a substance with dependency potential and as a positive dysfunctional reinforcer within complex behavioral patterns.

Material and methods: Narrative review of the pharmacological characteristics as well as the potential for misuse and addictive potential of propofol in the context of endoscopic interventions, based on published literature (case reports and retrospective studies).

Results and discussion: The literature reports euphoric and anxiolytic effects of propofol related to endoscopic procedures, which may persist beyond the immediate post-procedural period. In addition, a potential risk of propofol misuse and dependence is discussed in the context of endoscopic interventions. When indirect propofol misuse is suspected in the setting of intentional foreign body ingestion (iFBI), alternative sedation strategies should be considered.