Endoscopic removal of sharp foreign bodies impacted in the esophagus

Feasibility and safety of a self-developed sleeve for the endoscopic removal of refractory foreign body incarceration

Objective

This study aimed to assess the feasibility and safety of a novel self-designed sleeve for the endoscopic removal of a refractory incarcerated foreign body in the upper gastrointestinal tract (UGIT).

Methods

An interventional study was conducted between June and December 2022. A total of 60 patients who underwent an endoscopic removal of a refractory incarcerated foreign body from the UGIT were randomly allocated to the self-developed sleeve and the conventional transparent cap. The study evaluated and compared the operation time, successful removal rate, new injury length at the entrance of the esophagus, new injury length at the impaction site, visual field clarity, and postoperative complications between the two groups.

Results

The success rates of the two cohorts in the foreign body removal display no significant discrepancy (100% vs. 93%, P = 0.529). Nevertheless, the methodology of the novel overtube-assisted endoscopic foreign body removal has culminated in a significant reduction in the removal duration [40 (10, 50) min vs. 80 (10, 90) min, P = 0.01], reduction in esophageal entrance traumas [0 (0, 0) mm vs. 4.0 (0, 6) mm, P < 0.001], mitigation of injuries at the location of the foreign body incarceration [0 (0, 2) mm vs. 6.0 (3, 8) mm, P < 0.001], an enhanced visual field (P < 0.001), and a decrement in postoperative mucosal bleeding (23% vs. 67%, P < 0.001). The self-developed sleeve effectively negated the advantages of incarceration exclusion during removal.

Conclusion

The study findings support the feasibility and safety of the self-developed sleeve for the endoscopic removal of a refractory incarcerated foreign body in the UGIT, with advantages over the conventional transparent cap.

Endoscopic Removal Through a Gastrostomy of Swallowed Acupuncture Needles

Acupuncture is a representative treatment field in oriental medicine that is used widely in various medical conditions. Although acupuncture is considered a safe procedure, it can cause complications. This paper reports the case of a 44-year-old quadriplegic woman who received a percutaneous gastrostomy (PEG) tube and was referred for the endoscopic removal of swallowed acupuncture needles. The needles were removed successfully by endoscopy through the PEG tube using the rendezvous technique without significant complications.

Conservative management of oesophageal soft food bolus impaction

BACKGROUND

Impaction of a soft food bolus in the oesophagus causes dysphagia and regurgitation. If the bolus does not pass spontaneously, then the patient is at risk of aspiration, dehydration, perforation, and death. Definitive management is with endoscopic intervention, recommended within 24 hours. Prior to endoscopy, many patients undergo a period of observation, awaiting spontaneous disimpaction, or may undergo enteral or parenteral treatments to attempt to dislodge the bolus. There is little consensus as to which of these conservative strategies is safe and effective to be used in this initial period, before resorting to definitive endoscopic management for persistent impaction.

OBJECTIVES

To evaluate the efficacy of non-endoscopic conservative treatments in the management of soft food boluses impacted within the oesophagus.

SEARCH METHODS

We searched the following databases, using relevant search terms: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and CINAHL. The date of the search was 18 August 2019. We screened the reference lists of relevant studies and reviews on the topic to identify any additional studies.

SELECTION CRITERIA

We included randomised controlled trials of the management of acute oesophageal soft food bolus impaction, in adults and children, reporting the incidence of disimpaction (confirmed radiologically or clinically by return to oral diet) without the need for endoscopic intervention. We did not include studies focusing on sharp or solid object impaction.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures recommended by Cochrane.

MAIN RESULTS

We identified 890 unique records through the electronic searches. We excluded 809 clearly irrelevant records and retrieved 81 records for further assessment. We subsequently included one randomised controlled trial that met the eligibility criteria, which was conducted in four Swedish centres and randomised 43 participants to receive either intravenous diazepam followed by glucagon, or intravenous placebos. The effect of the active substances compared with placebo on rates of disimpaction without intervention is uncertain, as the numbers from this single study were small, and the rates were similar (38% versus 32%; risk ratio 1.19, 95% confidence interval 0.51 to 2.75, P = 0.69). The certainty of the evidence using GRADE for this outcome is low. Data on adverse events were lacking.

AUTHORS' CONCLUSIONS

There is currently inadequate data to recommend the use of any enteral or parenteral treatments in the management of acute oesophageal soft food bolus impaction. There is also inadequate data regarding potential adverse events from the use of these treatments, or from potential delays in definitive endoscopic management. Caution should be exercised when using any conservative management strategies in these patients.

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.

The Management of Voluntary Ingestion of Razor Blades by Inmates

Ingestion of sharp objects is a rare event. We report our experience in the care of prisoners who ingested razor blades and the in-time evolution of our management. This is a descriptive study including all detainees ingesting a razor blade, transferred from the prison to Farhat Hached University Hospital of Sousse, from January 1, 2014 to December 31, 2015. Thus, we counted 19 cases of swallowed razor blades in 16 prisoners; indeed, 1 prisoner ingested a razor blade three times and another had ingested a blade twice. Our study includes 19 episodes of swallowed razor blades. In 2 cases, these events were secondary to suicide attempts. In the other cases, it was an expression of discontent and rejection of the situation in the prison. Three patients had a psychiatric history. The mean age of the patients is 24 years. The initial clinical examination had not objectified signs of gastrointestinal perforation. Thoraco-abdomino-pelvic computed tomography scans allowed specifying the blade location in all cases. It also objectified a pneumo-mediastinum in 2 cases. The blade location was esophageal in 1 case, gastric in 6 cases, and in the small bowel in the other cases. The first 4 patients had surgical removal of the blade. In subsequent cases, surgical abstention was the rule, and spontaneous blade expulsion was observed. The average time of expulsion was 4 days. In our experience, surgical removal of sharp foreign bodies should not be performed systematically without complications.

Endoscopic Removal of Ingested Dentures and Dental Instruments: A Retrospective Analysis

Background. Dentures and dental instruments are frequently encountered ingested foreign bodies. The aim of the present study was to assess the safety and efficacy of endoscopically removing ingested dental objects. Methods. Twenty-nine consecutive patients with 29 dental objects who were treated at the Niigata University Medical and Dental Hospital from August 2009 to December 2015 were retrospectively reviewed. Characteristics of the patients and the ingested dental objects, the clinical features and findings of radiological imaging tests, and outcomes of endoscopic removal were analyzed. Results. Patients' mean age was 62.9 ± 21.0 years. The ingested dental objects included 23 dentures (13 crowns, 4 bridges, 4 partial dentures, and 2 other dentures) and 6 dental instruments. Twenty-seven upper gastrointestinal endoscopies and 2 colonoscopies were performed, and their success rates were 92.6% and 100%, respectively. There were 2 cases of removal failure; one case involved an impacted partial denture in the cervical esophagus, and this case required surgical removal. Conclusions. Endoscopic removal of ingested dentures and dental instruments is associated with a favorable success rate and acceptable complications. The immediate intervention and appropriate selection of devices are essential for managing ingested dental objects.

A Timely Intervention: Endoscopic Retrieval of a Swallowed Magnetized Activity Watch

The accidental ingestion of a foreign object often presents a difficult scenario for the clinician. This includes not only the decision to retrieve the material but also the appropriate technique to use. We present the case of a young asymptomatic girl who swallowed a magnetic activity watch, which was then successfully retrieved with an endoscopic snare. To our knowledge, this is the first documented case of salvaging an operational watch from the stomach using an endoscopic technique.

Salvage technique for endoscopic removal of a sharp fish bone impacted in the esophagus using a transparent cap and detachable snares

A sharp, impacted fish bone in the esophagus is an indication for urgent endoscopy. Endoscopic removal of such an object is a challenging task. An endoscopic protector hood is then used to remove the object. However, an endoscopic hood protector is not always available. In a patient with a large hiatal hernia, the protector hood may not return to the original shape when it passes through the gastroesophageal junction and therefore may not properly protect the esophageal mucosa from the sharp foreign body. In our case, it was impossible to deploy the endoscopic hood protector through the gastroesophageal junction despite multiple attempts. We propose an alternative solution for such cases. We safely removed a large sharp-edged flat fish bone that was folded and compressed using a detachable snare after releasing and pushing the fish bone into the stomach using an endoscope equipped with a transparent cap used for dilating the esophageal wall. This method of using an endoscopic cap and detachable snare is a safe, useful alternative for endoscopically removing a large sharp-edged flat foreign body from the upper gastrointestinal tract. This alternative technique has not been reported in the English medical literature.

Transparent cap-assisted endoscopic management of foreign bodies in the upper esophagus: a randomized, controlled trial

OBJECTIVES

Ingestion of foreign bodies (FBs) in the upper esophagus is common in South China. It is difficult to manage because of limited working space and inadequate visual field in this area. This randomized, controlled study aimed to evaluate the usefulness of a transparent cap in the endoscopic management of FBs in the upper esophagus.

METHODS

Adult patients suspected of FBs in the upper esophagus based on the history of FBs ingestion, symptoms, and barium contrast examination were screened for the study between March 1, 2009 and December 31, 2010. Seventy patients with endoscopic-confirmed FBs in the upper esophagus were recruited and were randomly assigned to two groups: transparent cap-assisted esophagogastroduodenoscopy group (n = 35) or conventional esophagogastroduodenoscopy group (n = 35). The type, size, and location of FBs, the operation time for removing the FBs, and the clearness of visual field were compared between these two groups.

RESULTS

The type, size, and location of FBs were similar between the two groups (P > 0.05). The average operation time for removing the FBs was significantly shorter in the transparent cap-assisted group than in the conventional group (2.6 min vs 4.1 min, P = 0.008). Visual field was rated as "clear" in more cases in the transparent cap-assisted group than in the conventional group (97.1% vs 25.7%, P < 0.0001).

CONCLUSIONS

Transparent cap-assisted endoscopy was a safe and effective method in the management of FBs in the upper esophagus, with a shorter operation time and clearer visual field.

Successful endoscopic band ligation of esophageal perforation by fish bone ingestion

Acute esophageal perforations by foreign body ingestion result in complications such as mediastinitis and retropharyngeal or parapharyngeal abscesses. Because the mortality of esophageal perforation is up to 22%, immediate treatment is critical. Herein, we report a case of successful endoscopic band ligation of esophageal perforation. A 68-year-old man was admitted complaining of substernal pain and dysphagia after ingesting a fish bone. Immediately emergency endoscopy was performed, and the fish bone was observed lodged in the lower esophagus. Although the fish bone was easily removed by an endoscopic rat-tooth forceps, esophageal perforation was found after the procedure. Endoscopic band ligation for perforation was performed. Initial chest computed tomography (CT) showed pneumomediastinum and local inflammation, but follow-up CT showed improved pneumomediastinum. The patient was given oral nutrition 2 weeks after procedure, and he was discharged without any complications. This case report emphasizes for the first time the availability of immediate endoscopic band ligation for acute esophageal perforation.

[Foreign bodies in the upper gastrointestinal tract]

Foreign bodies in the upper GI tract are an important medical problem and cause about 5% of emergency endoscopies. Endoscopic removal is the method of the choice and is successful in 99% of cases. Nevertheless, endoscopic removal is not necessary in every case because most foreign bodies can pass through the digestive tract and be evacuated in the natural way. An immediate emergency endoscopy is indicated for foreign bodies in the esophagus with signs of obstruction, which is present in more than 75% of cases, because the risk of complications increases with retention time. The endoscopist has myriad possibilities for finding the best and safest way to extract the foreign body.

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.

Denture impacted in the oesophagus for 9 months: successful endoscopic retrieval

This case report describes the presentation and successful endoscopic retrieval of an impacted denture plate from the distal oesophagus where it had been in-situ for nine months.

Endoscopic management of foreign bodies in the upper gastrointestinal tract in South China: a retrospective study of 561 cases

OBJECTIVES

Ingestion of a foreign body (FB) is a common occurrence; however, few studies have reported its characteristics and endoscopic management in South China. The aim of this study is to investigate the clinical features of FB ingestion in South China and report its management through endoscopy.

METHODS

Data were collected from all consecutive patients with suspected FB ingestion accepting endoscopic management in our endoscopy center during the past 10 years. The demographic data, clinical presentations, and endoscopic management were reviewed and analyzed retrospectively.

RESULTS

A total of 561 patients with suspected FB ingestion underwent endoscopic management. Among them, 447 FBs were found in 439 (78.3%) patients. Fish bone ingestion was most common (60.4%). Most of the FBs were located in the esophagus (84.5%). The majority of patients (96.1%) were successfully treated with flexible endoscopy with the addition of suitable devices without any serious procedure-related complications. There was a significant difference in the types of FBs between the former and latter 5 years (P < 0.05), and fish bone ingestion became more prevalent with time. Compared with the conventional methods, a new technique with a reworked transparent cap was successful in dealing with small sharp FBs impacted at the entrance of esophagus. The new technique had a shorter operation time (11.7 versus 17.9 min, P = 0.02) and an increased success rate (by 8%).

CONCLUSIONS

In South China, fish bone is the most common FB found in the upper gastrointestinal tract. Endoscopic management is a safe and effective approach in managing FBs. A new technique with reworked transparent cap is useful and promising, but further study is needed for confirmation.

Esophageal large fish bone (sea bream jawbone) impaction successfully managed with endoscopy and safely excreted through the intestinal tract

A 68-year-old man consulted our hospital because of back pain. A chest computed tomography (CT) demonstrated a high-density foreign body in the esophageal wall. There was no evidence of pneumomediastinum. Endoscopic examination demonstrated a large fish bone that was stuck in the esophageal wall. It was dislodged and moved into the stomach. The bone was excreted through the intestinal tract on the seventh hospital day. Unintentional ingestion of large fish bones must be considered potentially dangerous. Complications such as esophageal perforation or mediastinitis should be confirmed by CT; and then, the esophageal foreign body should be removed as soon as possible.

[Foreign body perforation of the thoracic esophagus]

BACKGROUND

Esophageal perforation due to foreign body (FB) ingestion is an unusual occurrence. This study aims to define diagnostic difficulties of esophageal perforation by FB.

PATIENTS AND METHODS

A chart review of patients on our service with FB esophageal perforation was carried out. Diagnosis of perforation was made by CT scan and/or esophagoscopy. Surgery was indicated when a FB could not be removed endoscopically or on a case-by-case basis according to clinical/laboratory, radiologic, and/or endoscopic findings.

RESULTS

Seven patients (age range: 27 to 80 years) were admitted for esophageal FB perforation. All patients presented with dysphagia. Two patients presented with signs of sepsis more than 24 hours after FB ingestion. Perforation was diagnosed at initial evaluation in five cases (three by endoscopy, two by CT) and after FB extraction in two cases. Six patients underwent surgery (suture repair: n=4; esophageal exclusion: n=1; mediastinal drainage: n=1). Five surgeries were performed at the initial diagnosis and one after failure of medical management. Mortality was zero; one patient developed esophageal fistula.

CONCLUSION

Diagnosis of FB esophageal perforation is difficult and is delayed in up to a quarter of patients. The perforation can be due to the FB itself or may be incurred during endoscopic extraction. Both CT and endoscopy are necessary for diagnosis and treatment. Most patients require surgical intervention.

Removal of press-through-packs impacted in the upper esophagus using an overtube

Foreign bodies in the upper esophagus should be removed as soon as possible to avoid serious complications. However, removals of foreign bodies in the upper esophagus are very difficult, especially if they have sharp edges, such as press-through-packs (PTPs). We experienced four cases of the impacted PTPs in the upper esophagus which was successfully extracted endoscopically with the overtube. Because two edges of PTPs were so firmly impacted in the esophageal wall in all cases, the PTPs were not movable in the upper esophagus. However, after insertion of the overtube, PTPs became movable and were successfully extracted and no serious complications occurred after extraction of PTPs. In one case, insertion of the overtube rapidly expanded the upper esophagus and PTP progressed to the gastric cavity and it could be extracted with the endoscopic protector hood. The endoscopic removal with the overtube was a simple, safe and effective technique for the removal of the impacted PTPs in upper esophagus.

An amazing case of working wrist watch in the esophagus

Foreign bodies in the esophagus are commonly seen in otolaryngologic practice. We report the successful removal of a working wrist watch dial lodged for one month in the esophagus of an adult schizophrenic patient, which is a rare incident.