The Management of Foreign Bodies in the Pharynx and Oesophagus Using Transnasal Flexible Laryngooesophagoscopy (TNFLO)

Abstract

INTRODUCTION We describe our experience of the diagnosis and removal of foreign bodies from the pharynx and oesophagus using transnasal flexible laryngo-oesophagoscopy (TNFLO) under local analgesic. The advantages of this novel instrumentation and technique are discussed.PATIENTS AND METHODS Patients were examined with a Pentax 80K Series Digital Video Endoscope after local analgesia. The instrument was passed transnasally examining the oro-and hypopharynx, and then passed into the oesophagus. The presence, type and site of a foreign body could then be established. If a foreign body was detected, such as fish bone, it was extracted using flexible grabbing forceps passed down the instrument channel and delivered through the nasal or oral cavity. The object was then inspected to ensure removal in its entirety. RESULTS Five cases have been successfully managed using TNFLO. CONCLUSIONS TNFLO represents an improvement in the diagnosis and subsequent treatment of a selected group of foreign bodies as compared with established methodologies.

Changing Trends in Oesophageal Endoscopy: A Systematic Review of Transnasal Oesophagoscopy

“…Two of the foreign bodies were extracted via the nose, one extracted via the mouth, one pushed into the stomach, and one removed by direct pharyngoscopy under general anaesthesia. The authors concluded that TNE represents an improvement in the diagnosis and subsequent treatment of a selected group of foreign bodies as compared with established methodologies [26]. …”

“…In a study for detection of metachronous oesophageal carcinoma in patients with HNSCC, Su et al reported that the entire transnasal oesophagoscopy procedure time, including evaluation of upper aerodigestive tract and multiple biopsies of suspicious lesions, ranged from 10 to 40 minutes (median, 15 minutes) [21]. Bennett et al reported an overall procedure time of less than 20 minutes, while recovery and discharge were possible one hour later in their study on management of patients with foreign bodies in the pharynx and oesophagus [26]. …”

Unsedated small caliber esophagogastroduodenoscopy: Can we trust this technique?

“…This combination proves useful in the evaluation of esophageal peristaltic function, such as in the diagnosis of gastroesophageal reflux disease (35). The small caliber transnasal endoscope was also reported to be valuable in the management of foreign bodies in the pharynx and esophagus (36). Small caliber endoscopy with narrow band imaging and Lugol staining to screen patients with head and neck cancer are important in such cases with some limitations for oral intubation with conventional endoscopes.…”

Management of Foreign Bodies of Upper Digestive Tract

“…However, 10-20% will require non-operative intervention and only 1% will need surgery [2,4]. Frequently ingested items include small metal, plastic toys, coin, button batteries, fish bones, safety pin, thumbtacks, needles, wire, wood or glass objects, denture, bolus meat and razor blade [5]. Its presentation may be varied include odynophagia, dysphagia or choking.…”

“…Nevertheless, big and sharp edge FB has higher possibilities to cause complication such as abscess and esophageal perforation. Therefore, impacted FB requires urgent surgical attention and rigid esophagoscopy is the procedure of choice to remove the FB under control environment [5,9].…”