Endoscopic Management of Foreign Bodies in the Gastrointestinal Tract

Survey of Instruments and Techniques for Endoscopic Retrieval of Esophageal and Gastric Foreign Bodies in Cats and Dogs

Esophageal and gastric foreign bodies (EFB and GFB) are a common occurrence in cats and dogs. The objective of this study is to evaluate the endoscopic instruments and techniques used for foreign body retrieval by internists or criticalists based on type and location of the foreign body. An online, anonymous survey was created using a commercial software. The survey was distributed to diplomates of the ACVIM (SAIM) and ACVECC through each college's listserv. Data obtained included specialty, years in practice, practice type, available instruments, and preferred instrument for various foreign bodies by location and type. Two hundred sixty-eight surveys were completed with 74% from private referral practice and 21% from academic practice. For EFB, laparoscopic or endoscopic grasping forceps were used most commonly. For GFB, grasping forceps or loop snares were used most commonly. Fifty percent of respondents reported attempting duodenal FB removal. In practices with limited financial resources, endoscopic grasping forceps and loop snares may be prioritized for purchase as these instruments may have the most application for foreign body retrieval from the esophagus and stomach.

Esophageal emergencies: another important cause of acute chest pain

A variety of esophageal pathologies can present emergently with a chief complaint of acute chest pain. Computed tomography (CT) is often the first line of imaging in esophageal emergencies and provides useful information-even without an initial suspicion-when used in conjunction with other imaging modalities such as esophagography and direct visualization. We review various urgent and emergent esophageal disease entities which may manifest as acute chest pain, with an emphasis on CT and ancillary imaging appearances, while discussing management according to their emergency. Radiologists should be familiar with the imaging findings of these esophageal emergencies in order to provide an accurate diagnosis and recommend timely and appropriate management.

Fluoroscopy-Guided Endoscopic Removal of Foreign Bodies

In most cases of ingested foreign bodies, endoscopy is the first treatment of choice. Moreover, emergency endoscopic removal is required for sharp and pointed foreign bodies such as animal or fish bones, food boluses, and button batteries due to the increased risks of perforation, obstruction, and bleeding. Here, we presented two cases that needed emergency endoscopic removal of foreign bodies without sufficient fasting time. Foreign bodies could not be visualized by endoscopy due to food residue; therefore, fluoroscopic imaging was utilized for endoscopic removal of foreign bodies in both cases.

Successful Removal of a Screw Nail in the Jejunum Using Double-Balloon Enteroscopy

The vast majority of foreign bodies (FBs) that enter the stomach pass through the gastrointestinal tract spontaneously. When the FB enters the small bowel-beyond the reach of conventional endoscopy-daily radiographs are needed to ensure its safe passage. However, endoscopic intervention is an appropriate management strategy for a sharp-pointed FB, because sharp FBs have a higher risk of intestinal perforation. We describe here a case in which a 1.5-cm, sharp-pointed screw nail in the proximal jejunum was removed successfully by double-balloon enteroscopy from a 19-year-old-male with autism. This case adds to the growing body of evidence demonstrating the value of therapeutic double-balloon enteroscopy in the field of FB ingestion.