Endoscopic removal of sharp metallic foreign bodies

Abstract

Metallic foreign bodies have been re− moved under fluoroscopic control but this can be hazardous [1, 2]. We describe here an endoscopic method for removal of sharp metallic foreign bodies using a magnetic retrieval instrument we de− signed ourselves.After the trial was approved by the ethical committee and informed consent was ob− tained, ten patients who had ingested sharp foreign bodies were included in the study. Four people had ingested pins, four had ingested open safety pins, and two had ingested nails. Two were impacted and two were penetrating. Pentazocine (15 mg) and hyosine butylbromide (20 mg) were used as premedication. The time required, and the complication and failure rates were recorded.We used a stainless steel wire (200 cm in length, 0.75−mm thick) with two 7−mm− diameter magnetic discs with a strength of 0.17 tesla fixed at one end. A Teflon sheath (7 Fr, 160 cm) was used as a sleeve, and a ligator cylinder was used during for− eign−body retrieval (Figure 1). The cylin− der was fixed at the tip of the endoscope. The sheath was passed through the chan− nel to the tip of the endoscope. The wire end of the instrument was passed through the sheath so that the magnet was positioned at the tip of the endo− scope. As the endoscope reached the for− eign body, the magnet was pushed out and the foreign body stuck to the magnet. The foreign body and magnet were then drawn into the cylinder and the endo− scope was removed. All the foreign bodies were removed using this method without any complications in mean time of 68 sec− onds (range 46 ± 100 seconds).We used our instrument previously to re− move ferromagnetic coins [3, 4]. The sharp foreign bodies were light and so were attracted by the small magnet, and the pulling back of the magnet led to their disimpaction. Even the sharp foreign bod− ies that had penetrated could be pulled out because the head portion of the pins and safety pins could be visualized. The portion of the foreign body with a larger surface area had a tendency to stick to the magnet, meaning that the elongated sharp foreign bodies aligned themselves along their longitudinal axis (Figure 2). The sharp end of the foreign body fol− lowed the head, thus avoiding mucosal injury.

Endoscopic applications of magnets for the treatment of gastrointestinal diseases

“…Despite their effectiveness, removal of foreign bodies in some cases remains difficult and time-consuming, especially when visualization of the objects is obscured[75,76], when the objects are too small or numerous[77], or when the objects are inaccessible[78]. Magnet-assisted foreign body removal performed under endoscopic observation is reported to be beneficial for extracting various objects, including coins[79,80], button batteries[81], impacted magnets[51], paperclips[75], needles[77], nails[76,78,82], pins[82] and safety pains[82]. Forceps[51], snares[75], Roth nets[76,77], and loop baskets[79] are commonly used for magnet insertion.…”

Unique Method to Manage Ingested Magnets

“…A magnetic ball was put into a glove finger tied as a bag to a 2/0 suture wire and was back‐inserted through the endoscope. Unlikely other magnetic tools (6–8), the bag was kept 5 cm away from the tip of the endoscope to allow front view (Figs. 2 and 3).…”

Impacted nail in duodenum: endoscopic removal with a novel magnetic foreign body retriever

“…The endoscope was removed and reintroduced after a magnetic retrieval instrument had been attached to its tip (l " Fig. 2) [1,2]. Once the endoscope reached the antrum, the magnet was advanced further into the duodenal bulb under fluoroscopic guidance.…”