Endoscopic foreign body retrieval

Some patients at risk for foreign body ingestion may not be able to give an accurate medical history of ingestion, either due to age or mental illness. It is important that physicians treating these patients recognize the symptoms of esophageal foreign body impaction requiring urgent intervention. Most frequently, these include drooling and the inability to swallow saliva, neck tenderness, regurgitation of food, stridor and shortness of breath if there is compression of the trachea.{{cite journal | last1 = Nandi | first1 = P | last2 = Ong | first2 = GB | title = Foreign body in the oesophagus: review of 2394 cases | journal = The British Journal of Surgery | volume = 65 | issue = 1 | pages = 5–9 | year = 1978 | pmid = 623968 | doi=10.1002/bjs.1800650103| s2cid = 43510040 }}

There are several situations in which endoscopic techniques are not indicated, such as for small blunt objects less than 2.5 cm which have already passed into the stomach (as these usually do not obstruct anywhere else), when there is perforation of the esophagus or mediastinitis (inflammation of structures around the esophagus), and for narcotic-containing bags or condoms that have been ingested, because of the risk of overdose if they are ruptured.

Foreign bodies should be removed from the esophagus within 24 hours of ingestion because of a high risk of complication.{{cite journal | last1 = Chaikhouni | first1 = A | last2 = Kratz | first2 = JM | last3 = Crawford | first3 = FA | title = Foreign bodies of the esophagus | journal = The American Surgeon | volume = 51 | issue = 4 | pages = 173–9 | year = 1985 | pmid = 3985482 }}

File:Foreign body aspiration.jpg showing a Canadian dollar coin in the esophagus of a young child]]

Prior to undertaking endoscopy, attempts should be made to locate the foreign body with x-rays or other non-invasive techniques. For radio-opaque objects, x-rays of the neck, chest and abdomen can be used to locate the foreign body and assist endoscopy.{{cite journal | last1 = Lane | first1 = JE | last2 = Boltri | first2 = JM | title = Imaging gastric pennies in children | journal = Emergency Radiology | volume = 11 | issue = 3 | pages = 180–2 | year = 2005 | pmid = 16028326 | doi = 10.1007/s10140-004-0372-1 | s2cid = 27333104 }} Alternative approaches, including the use of metal detectors, have also been described.{{cite journal | last1 = Ramlakhan | first1 = SL | last2 = Burke | first2 = DP | last3 = Gilchrist | first3 = J | title = Things that go beep: experience with an ED guideline for use of a handheld metal detector in the management of ingested non-hazardous metallic foreign bodies | journal = Emergency Medicine Journal | volume = 23 | issue = 6 | pages = 456–60 | year = 2006 | pmid = 16714508 | pmc = 2564343 | doi = 10.1136/emj.2005.029553 }}

X-rays are also useful for identifying the type of foreign body ingested and complications of foreign body ingestion, including mediastinitis and perforation of the esophagus.

Endoscopic retrieval involves the use of a gastroscope or an optic fiber charge-coupled device camera. This instrument is shaped as a long tube, which is inserted through the mouth into the esophagus and stomach to identify the foreign body or bodies. This procedure is typically performed under conscious sedation. Many techniques have been described to remove foreign bodies from the stomach and esophagus. Usually the esophagus is protected with an overtube (a plastic tube of varying length), through which the gastroscope and retrieved objects are passed.{{Cite journal|pmid=16423316|year=2006|last1=Smith|first1=M. T.|title=Esophageal foreign bodies: Types and techniques for removal|journal=Current Treatment Options in Gastroenterology|volume=9|issue=1|pages=75–84|last2=Wong|first2=R. K.|doi=10.1007/s11938-006-0026-3|s2cid=23798796 }}

Once the foreign body has been identified with the gastroscope, various devices can be passed through the gastroscope to grasp or manipulate the foreign body. Devices used include forceps, which come in varying shapes, sizes and grips,{{cite journal | last1 = Seo | first1 = JK | title = Endoscopic management of gastrointestinal foreign bodies in children | journal = Indian Journal of Pediatrics | volume = 66 | issue = 1 Suppl | pages = S75–80 | year = 1999 | pmid = 11132474 }} snares, and oval loops that can be retracted from outside the gastroscope to lasso objects,{{cite journal | last1 = Chen | first1 = SC | last2 = Yu | first2 = SC | last3 = Yuan | first3 = RH | last4 = Chang | first4 = KJ | title = Endoscopic removal of a large gastric metallic watch with a polypectomy snare loop | journal = Endoscopy | volume = 29 | issue = 9 | pages = S55–6 | year = 1997 | pmid = 9476781 | doi = 10.1055/s-2007-1004333 | doi-access = free }} as well as Roth baskets (mesh nets that can be closed to trap small objects),{{cite journal | last1 = Neustater | first1 = B | last2 = Barkin | first2 = JS | title = Extraction of an esophageal food impaction with a Roth retrieval net | journal = Gastrointestinal Endoscopy | volume = 43 | issue = 1 | pages = 66–7 | year = 1996 | pmid = 8903823 | doi=10.1016/s0016-5107(96)70265-1}} and magnets placed at the end of the scope or at the end of orogastric tubes.{{cite journal | last1 = Yamauchi | first1 = K | last2 = Kobayashi | first2 = T | last3 = Shinomiya | first3 = T | last4 = Fujiwara | first4 = D | last5 = Ito | first5 = W | last6 = Onoda | first6 = T | last7 = Yozai | first7 = K | last8 = Ishii | first8 = T | last9 = Nanamiya | first9 = W | last10 = Sumiyoshi | first10 = Ryota | last11 = Ono | first11 = Takuya | last12 = Tamai | first12 = Mamoru | last13 = Yamane | first13 = Yukio | last14 = Suzaki | first14 = Norikazu | title = Device for the removal of button batteries | journal = Internal Medicine (Tokyo, Japan) | volume = 40 | issue = 1 | pages = 9–13 | year = 2001 | pmid = 11201377 | doi = 10.2169/internalmedicine.40.9 | display-authors = 8 | doi-access = free }} Some techniques have been described that use foley catheters to trap objects, or use two snares to orient foreign bodies.

In veterinary medicine or when there is no endoscope available to extract foreign bodies economically without operation the Hartmann alligator forceps can be used.{{cite journal |last1=Barsotti |first1=Giovanni |last2=Mannucci |first2=Tommaso |last3=Citi |first3=Simonetta |title=Ultrasonography-guided removal of plant-based foreign bodies from the lacrimal sac in four dogs |journal=BMC Veterinary Research |date=December 2019 |volume=15 |issue=1 |doi=10.1186/s12917-019-1817-9|doi-access=free |pmc=6402165 }}

• Bezoar
• Schatzki ring

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• [https://web.archive.org/web/20110723013156/http://rad.usuhs.edu/medpix/medpix.html?mode=single&recnum=1175 Esophageal Coin] MedPix Topic

Category:Digestive system procedures

Category:Emergency medical procedures

Category:Endoscopy