ASGE technology status evaluation report. Endoscopic retrieval devices. February 1999. American Society for Gastrointestinal Endoscopy

Adult Esophageal Foreign Bodies

This manuscript reviews and outlines the necessary tools to efficiently assess and manage an adult patient where an esophageal foreign body is suspected. It reviews the vulnerable populations and relevant diagnostics and provides a triage diagram to aid in timely intervention. Management with esophagoscopy is reviewed as well as potential complications that may arise. Lastly, to illustrate the concepts of this section, a case study is presented to highlight the salient points.

Foreign object ingestion and esophageal food impaction: An update and review on endoscopic management

Foreign body ingestion encompasses both foreign object ingestion (FOI) and esophageal food impaction (EFI) and represents a common and clinically significant scenario among patients of all ages. The immediate risk to the patient ranges from negligible to life-threatening, depending on the ingested substance, its location, patient fitness, and time to appropriate therapy. This article reviews the FOI and EFI literature and highlights important considerations and implications for pediatric and adult patients as well as their providers. Where published literature is insufficient to provide evidence-based guidance, expert opinion is included to supplement the content of this comprehensive review.

Foreign body embedded in the lower esophageal wall located by endoscopic ultrasonography: A case report

RATIONALE

Ingested esophageal foreign bodies are commonly seen in adult population. In very few instances, esophageal foreign body may pass through the mucosal surface, re-epithelialize or migrate into surrounding soft tissues.

PATIENT CONCERNS

A 55-year-old Chinese male was admitted to our hospital with a 10-day history chest and upper abdominal pain without dysphasia, cough or other symptoms.

DIAGNOSES

We initially suspected chronic gastritis, and thoracic computed tomography and endoscopy ultrasonography (EUS) were used to identify a fish bone completely embedded within the lower esophageal wall.

INTERVENTIONS

Under the EUS-guidance, we marked the foreign body using methylene blue with saline solution, which was followed by successful thoracoscopy and surgical removed of the foreign body.

OUTCOMES

The patient recovered well and was discharged 1 week postoperatively. One month postoperatively, the patient was symptom free and the chest wound was complete healed.

LESSONS

Our case showed that computed tomography is necessary to diagnose the esophageal foreign body, and EUS may help confirm the position of foreign body, especially those embedded in the esophageal submucosa. We advocate necessary surgery at the first accurate diagnosis in patient with esophageal foreign body when endoscopy is not possible.

Endoscopic Management of Foreign Bodies in the Gastrointestinal Tract: A Review of the Literature

Foreign body ingestion is a common diagnosis that presents in emergency departments throughout the world. Distinct foreign bodies predispose to particular locations of impaction in the gastrointestinal tract, commonly meat boluses in the esophagus above a preexisting esophageal stricture or ring in adults and coins in children. Several other groups are at high risk of foreign body impaction, mentally handicapped individuals or those with psychiatric illness, abusers of drugs or alcohol, and the geriatric population. Patients with foreign body ingestion typically present with odynophagia, dysphagia, sensation of having an object stuck, chest pain, and nausea/vomiting. The majority of foreign bodies pass through the digestive system spontaneously without causing any harm, symptoms, or necessitating any further intervention. A well-documented clinical history and thorough physical exam is critical in making the diagnosis, if additional modalities are needed, a CT scan and diagnostic endoscopy are generally the preferred modalities. Various tools can be used to remove foreign bodies, and endoscopic treatment is safe and effective if performed by a skilled endoscopist.

Novel low-cost endoscopic cap for esophageal foreign objects: a case report

A 57-year-old man presented to the hospital because of swallowing of a small marble precipitated by a hallucination. He subsequently developed chest discomfort. He had a history of psychiatric problem and an esophageal corrosive injury complicated by stricture of the middle esophagus.This report describes the novel idea of endoscopic intervention for the retrieval of an esophageal foreign body. Its inventiveness and the use of limited resources, by adapting a 30-mm aseptic common tubing into an endoscopic retrieving device, make the method novel. This novel low-cost endoscopic cap (NLCEC) was adapted to 25 mm of the front end of the endoscope, with 5 mm maintained for the soft part to prevent esophageal mucosal injury during the retrieval process. An 8-mm green marble was found impacted in the esophagus 32 cm from the incisors. The use of forced suction allowed for the successful retrieval of the marble within minutes. The patient had an uneventful recovery without any serious complications.This NLCEC may be a viable and safe tool for the endoscopic retrieval of esophageal foreign objects without general anesthesia. This innovative design is beneficial in terms of patient safety, easy preparation, and low cost.

An uncommon oesophageal foreign body in a neonate

We report a case of a 2-month-old male child who presented with sudden onset of vomiting and refusal to breast feed. Chest and abdomen examination were normal. A foreign body (zipper) was visualised in the cervical oesophagus on X-ray of the neck. The retrieval of the zipper by oesophagoscopy relieved the symptoms of the patient.

Foreign Body Endoscopy Experience of a University Based Hospital

BACKGROUND

Guidelines support endoscopic removal of certain gastric FB and all FB lodged in the esophagus. We aim to report our experience on endoscopic foreign bodies (FB) removal in order to aid in the formation of future guidelines regarding this subject.

METHODS

Retrospective analysis of one hundred forty-four cases of FB removal involving 43 patients who underwent esophagogastroduodenoscopy (EGD) for FB removal from January 2005 through December 2010 in a university-based hospital. To evaluate to outcome of endoscopic FB removal, cost of procedures and complications.

RESULTS

Of all FB removal cases, 23 (53%) were males, with total mean age of 26.4 ± 11.3 years. Only 20% were performed on an outpatient bases. Abdominal x-ray was obtained to confirm ingestion of FB in 83%, and computed tomography scan was performed in 13%. Most procedures were performed in operation room (59%) while only 21% of the cases were performed in endoscopy lab. General anesthesia was used in 58%, while monitored anesthesia care in 28%. Average time to EGD was 17.14 hours. No major complications due to procedure were reported. Minor trauma and erosions due to FB were reported in 14%. FB extraction was unsuccessful in only three cases, and one case required surgical intervention. Cost of all procedures was over 430, 000 dollars with mean of 2,990 dollars for procedure.

CONCLUSION

Endoscopic retrieval is effective and safe procedure, but utilizes significant hospital resources.

Alternative salvage technique for removing large sharp foreign body near upper esophageal sphincter

Removing sharp foreign bodies located in the esophagus can be dangerous and challenging. Proper apparatus and appropriate technique should be employed to avoid life-threatening complications such as perforation and mediastinitis. A 59-year-old man came to the emergency department with foreign body sensation in the upper esophagus which proved to be a large sharp fish bone impacted near upper esophageal sphincter. With the ordinary upper endoscope, the foreign body could not be retrieved even with the assistance of a cap. Foreign body removal was attempted again using a colonoscope with cap fitted at the end. Larger caliber of the scope rendered more stable support within the lumen enabling better maneuver of the scope tip to secure wider working space, and application of the cap permitted better visual field. Herein, we report the first case of successful removal of a large sharp fish bone impacted near the upper esophageal sphincter using cap assisted colonoscope.

Esophageal food impaction: a homemade suction tube attached to esophagogastroduodenoscopy for food bolus removal

The most common esophageal foreign body in adults is impacted food bolus. Polypectomy snares, Dormia baskets, retrieval nets, rat-tooth forceps, alligator forceps or polyp graspers are usually used to remove it. Here, we report the case of a 78-year-old woman whose esophagogastroduodenoscopy (EGD) showed a firm goose liver impacted tightly in the lower esophagus; all of the above-mentioned retrieval instruments could not remove it. We used a homemade device by attaching a modified nasogastric tube to an EGD and successfully removed the goose liver by suction under endoscopic visualization. The method is very effective to remove firm and tightly impacted materials in a narrow lumen. When the usual retrieval instruments fail, a homemade suction tube attached to an EGD is an alternative.

Retrieval of colorectal polyps following snare polypectomy: Experience of the multiple-suction technique in 602 cases

BACKGROUND

Retrieving colorectal polyp after endoscopic snare polypectomy is time consuming and possibly incurs a failure. The aim of the study was to assess the effectiveness of the multiple-suction (M-S) technique for retrieving a variety of polyps.

MATERIALS AND METHODS

Four hundred and nine cases received endoscopic snare polypectomy from January 2003 to January 2007 were reviewed. The resected polyps were retrieved by M-S technique, in which suction regarded as the leading technique, was taken in combination with channel occlusion, trap, snare, and grasping forcep. Time of cecal intubation and of polypectomy, total examination time, shape, size, location, and number of polyp(s) were recorded. Retrieval time and polyp lost rate were also noted.

RESULTS

A total of 602 polyps more than 3 mm in diameter underwent snare polypectomy. There were 96.7% (582/602) of polyps retrieved by the M-S technique. The mean retrieval time was 1.5 +/- 0.6 min. Time of polypectomy, retrieval time, and total examination time were significantly positive correlative with the number of polyps (P < 0.05). In a univariate analysis, longer retrieval time was significantly associated with larger polyps, more distant polyps from the anus, and a greater number of polyps, while higher polyp lost rate was significantly associated with sessile polyp, smaller polyps, and a greater number of polyps. In a multivariate analysis, retrieval time level (< or = 2.0 or >2.0 min) was linked to the number of polyps.

CONCLUSIONS

The M-S technique is proved to be reliable when used in the majority cases of colorectal polyp retrieval. In retrieving too many polyps, the M-S technique is time consuming, and hence, additional methods should be applied to improve its retrieval effectiveness.

Recurrent laryngeal nerve palsy due to impacted dental plate in the thoracic oesophagus: case report

Background

Retained oesophageal foreign bodies must be urgently removed to prevent potentially serious complications. Recurrent laryngeal nerve palsy is rare and has not been reported in association with a foreign body in the thoracic oesophagus.

Case presentation

We present a case of a dental plate in the thoracic oesophagus that caused high dysphagia. Delayed diagnosis led to a recurrent laryngeal nerve palsy, which persisted despite successful surgical removal of the foreign body.

Conclusion

Oesophagoscopy is essential to fully assess patients with persistent symptoms after foreign body ingestion, irrespective of the level of dysphagia. Recurrent laryngeal nerve palsy may indicate impending perforation and should prompt urgent evaluation and treatment.

Foreign bodies

The spectrum of gastrointestinal (GI) foreign bodies includes food bolus impaction in the esophagus, nonfood objects that are swallowed, and various objects that may be inserted into the rectum. The risk depends upon the type of object and its location. Fortunately, 80% to 90% of ingested foreign bodies will pass without intervention. Objects with sharp edges or pointed tips have the highest risk of complications, up to 35%. All objects impacted in the esophagus require urgent or emergent treatment. Rectal foreign bodies are usually removable transanally, although general anesthesia and operative intervention sometimes are required.

Endoscopic management of foreign bodies in the upper-GI tract: experience with 1088 cases in China

BACKGROUND

Reports on endoscopic management of ingested foreign bodies of the upper-GI tract in China are scarce.

OBJECTIVE

To report our experience and outcome in the management of ingestion of foreign bodies in Chinese patients.

SETTING AND PATIENTS

Between January 1980 and January 2005, a total of 1088 patients (685 men and 403 women; age range, 1 day to 96 years old) with suspected foreign bodies were admitted to our endoscopy center.

INTERVENTIONS

All patients underwent endoscopic procedure after admission.

MAIN OUTCOME MEASUREMENTS

Demographic and endoscopic data, including age, sex, and referral sources of patients, types, number and location of foreign bodies, associated upper-GI diseases, endoscopic methods, and accessory devices for removal of foreign bodies were collected and analyzed.

RESULTS

A total of 1090 foreign bodies were found in 988 (90.8%) patients. The types of foreign bodies varied greatly: mainly food boluses, coins, fish bones, dental prostheses, or chicken bones. The foreign bodies were located in the pharynx (n = 12), the esophagus (n = 577), the stomach (n = 441), the duodenum (n = 50), and the surgical anastomosis (n = 10). The associated GI diseases (n = 88) included esophageal carcinoma (33.0%), stricture (23.9%), diverticulum (15.9%), postgastrectomy (11.4%), hiatal hernia (10.2%), and achalasia (5.7%). A rat-tooth forceps and a snare were the most frequently used accessory devices. The success rate for foreign-body removal was 94.1% (930/988).

CONCLUSIONS

Ingestion of foreign bodies is a common clinic problem in China. Endoscopy procedures are frequently performed, and a high proportion of patients with foreign bodies require endoscopic intervention.

Esophageal foreign bodies: Types and techniques for removal

Patients with esophageal foreign bodies require prompt diagnosis and therapy. The first tasks are to determine the type of object, time since ingestion, location of the object, and the likelihood of associated complications. Patients who have evidence of complete esophageal occlusion or who have ingested a sharp or pointed object require urgent treatment due to the increased risk of complications. Button batteries are particularly injurious in the esophagus and should be removed immediately. Coins in the esophagus should also be removed; however, a brief period of observation is appropriate for coins in the distal esophagus, as some will pass spontaneously. Flexible endoscopy is the therapeutic modality of choice for most patients. The key principles for endoscopic management of esophageal foreign bodies are to protect the airway, to maintain control of the object during extraction, and to avoid causing additional damage. Endotracheal intubation is sometimes necessary, especially in younger children and those at higher risk for aspiration. The use of devices such as an esophageal overtube and a latex protector hood may facilitate safer extraction of sharp/pointed objects. Patients with food impactions usually require treatment of an associated structural lesion of the esophagus.

Intraprocedural steps to enhance efficiency

This section focuses on intraprocedural steps that can improve endoscopic efficiency. Contributors to procedural efficiency and inefficiency are considered. The limitations to enhancing efficiency are presented. Strategies for incorporating contributors to efficiency including techniques, technologies, accessories, and attitudes are presented.

Guideline for the management of ingested foreign bodies

This is one of a series of statements discussing the utilization of gastrointestinal endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations.

Polyp retrieval after colonoscopic polypectomy: use of the Roth Retrieval Net

BACKGROUND

All colon polyps removed during colonoscopy should be recovered and submitted for histopathologic analysis. Published information is scant regarding techniques and devices for retrieval of polyps after polypectomy. The Roth Retrieval Net is a novel device that has been used to retrieve foreign bodies from the GI tract, but its use as a polyp retrieval device has not previously been described.

METHODS

A chart review was conducted over a 7-month period by one gastroenterologist in an office setting of all patients who had polyps retrieved after piecemeal polypectomy by using the Roth Retrieval Net.

RESULTS

All resected polyps were completely retrieved in a time-efficient manner. Histopathologic evaluation was not compromised by the use of this device.

CONCLUSIONS

The Roth Retrieval Net is well suited for retrieval of multiple polyp fragments after colonoscopic polypectomy.