Esophageal foreign bodies: Types and techniques for removal

Abstract

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.

Miniature Netting System for Endoscopic Object Retrieval From Hard-to-Reach Area

“…Simplified cross-sectional drawing of a flat object lodged in esophagus passageway, which may even be stretched. An existing endoscopic retrieval net [15], [18] cannot be deployed around the object, as there is no space to pass through at the two stretched points. Fig.…”

“…This difficulty could result in accidental loss or deformation of the grabbed object if it is not grabbed properly, leading to even more serious consequences. Completely wrapping around the target object rather than grabbing it, endoscopic retrieval nets [15], [18] provide a safer and more reliable removing process. However, if a flat object is firmly lodged, pushing against the esophagus walls as illustrated in Fig.…”

Interventional upper endoscopy: The pediatric perspective

“…Narrowing of the esophagus occurs at the cricopharyngeal muscle of the upper esophageal sphincter (the narrowest point in the GI tract), the aortic arch, the left mainstem bronchus, and the LES [22,23]. Endoscopy is urgent in patients having difficulty handling oral secretions, to prevent aspiration [24].…”

“…For food impactions, a non-urgent endoscopy within the first 6 to 12 hours after ingestion is recommended before the food bolus has a chance to soften while in the esophagus and to minimize the pressure-induced mucosal damage caused by the food bolus [23]. Extraction can be attempted using a polypectomy snare or a Roth retrieval net (US Endoscopy, Mentor, OH).…”

“…Eighty to ninety percent of ingested foreign objects that reach the stomach will pass uneventfully, but it is important to be aware of which objects do require removal [23]. Almost all sharp objects in the stomach should be considered for immediate removal due to reported perforation rates between 15% and 35% [26].…”