Endoscopic foreign body retrieval

Endoscopic foreign body retrieval refers to the removal of ingested objects from the esophagus, stomach and duodenum by endoscopic techniques. It does not involve surgery, but rather encompasses a variety of techniques employed through the gastroscope for grasping foreign bodies, manipulating them, and removing them while protecting the esophagus and trachea.Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF, Mallery JS, Raddawi HM, Vargo JJ 2nd, Waring JP, Fanelli RD, Wheeler-Harbough J; American Society for Gastrointestinal Endoscopy. Guideline for the management of ingested foreign bodies. "Gastrointest Endosc." 2002 Jun;55(7):802-6. PMID 12024131] It is of particular importance with children, [Kay M, Wyllie R. Pediatric foreign bodies and their management. "Curr Gastroenterol Rep." 2005 Jun;7(3):212-8. PMID 15913481.] people with mental illness,Webb WA. Management of foreign bodies of the upper gastrointestinal tract: update. "Gastrointest Endosc." 1995 Jan;41(1):39-51. PMID 7698623] and prison inmates [O'Sullivan ST, Reardon CM, McGreal GT, Hehir DJ, Kirwan WO, Brady MP. Deliberate ingestion of foreign bodies by institutionalised psychiatric hospital patients and prison inmates. "Ir J Med Sci." 1996 Oct-Dec;165(4):294-6.] as these groups have a high rate of foreign body ingestion.

Commonly swallowed objects include coins, buttons, batteries, and small bones (such as fish bones), but can include more complex objects, such as eyeglasses,Grover SC, Kim YI, Kortan PP, Marcon NE. Endoscopic removal of eight gastric foreign bodies ingested sequentially in twelve days: a case of creative endoscopy. Abstract presented at "World Congress of Gastroenterology", Montreal, Canada, September 2005.] spoons,Aoyagi K, Maeda K, Morita I, Eguchi K, Nishimura H, Sakisaka S. Endoscopic removal of a spoon from the stomach with a double-snare and balloon. "Gastrointest Endosc." 2003 Jun;57(7):990-1. PMID 12776067] and toothbrushes (see image).

Indications and contraindications

Some patients at risk for foreign body ingestion may not be able to give an accurate medical history of ingestion, either due to age or mental illness. It is important that physicians treating these patients recognize the symptoms of esophageal foreign body impaction requiring urgent intervention. Most frequently, these include drooling and the inability to swallow saliva, neck tenderness, regurgitation of food, stridor and shortness of breath if there is compression of the trachea. [Nandi P, Ong GB. Foreign body in the oesophagus: review of 2394 cases. "Br J Surg." 1978 Jan;65(1):5-9. PMID 623968]

There are several situations in which endoscopic techniques are not indicated, such as for small blunt objects less than 2.5 cm which have already passed into the stomach (as these usually do not obstruct anywhere else), when there is perforation of the esophagus or mediastinitis (inflammation of structures around the esophagus), and for narcotic-containing bags or condoms that have been ingested, because of the risk of overdose if they are ruptured.

Foreign bodies should be removed from the esophagus within 24 hours of ingestion because of a high risk of complication. [Chaikhouni A, Kratz JM, Crawford FA. Foreign bodies of the esophagus. "Am Surg." 1985 Apr;51(4):173-9. PMID 3985482]

Non-invasive testing

Prior to undertaking endoscopy, attempts should be made to locate the foreign body with x-rays or other non-invasive techniques. For radio-opaque objects, x-rays of the neck, chest and abdomen can be used to locate the foreign body and assist endoscopy. [Lane JE, Boltri JM. Imaging gastric pennies in children. "Emerg Radiol." 2005 Apr;11(3):180-2. PMID 16028326] Alternative approaches, including the use of metal detectors, have also been described. [Ramlakhan SL, Burke DP, Gilchrist J. Things that go beep: experience with an ED guideline for use of a handheld metal detector in the management of ingested non-hazardous metallic foreign bodies. "Emerg Med J." 2006 Jun;23(6):456-60. PMID 16714508]

X-rays are also useful for identifying the type of foreign body ingested and complications of foreign body ingestion, including mediastinitis and perforation of the esophagus.

Endoscopy

Endoscopic retrieval involves the use of a gastroscope or an optic fiber charge-coupled device camera. This instrument is shaped as a long tube, which is inserted through the mouth into the esophagus and stomach to identify the foreign body or bodies. This procedure is typically performed under conscious sedation. Many techniques have been described to remove foreign bodies from the stomach and esophagus. Usually the esophagus is protected with an overtube (a plastic tube of varying length), through which the gastroscope and retrieved objects are passed. [Smith MT, Wong RK. Esophageal foreign bodies: types and techniques for removal. "Curr Treat Options Gastroenterol." 2006 Feb;9(1):75-84.]

Once the foreign body has been identified with the gastroscope, various devices can be passed through the gastroscope to grasp or manipulate the foreign body. Devices used include forceps, which come in varying shapes, sizes and grips,Seo JK. Endoscopic management of gastrointestinal foreign bodies in children. "Indian J Pediatr." 1999;66(1 Suppl):S75-80. PMID 11132474] snares, and oval loops that can be retracted from outside the gastroscope to lasso objects, [Chen SC, Yu SC, Yuan RH, Chang KJ. Endoscopic removal of a large gastric metallic watch with a polypectomy snare loop. "Endoscopy." 1997 Nov;29(9):S55-6. PMID 9476781 ] as well as Roth baskets (mesh nets that can be closed to trap small objects), [Neustater B, Barkin JS. Extraction of an esophageal food impaction with a Roth retrieval net. "Gastrointest Endosc." 1996 Jan;43(1):66-7. PMID 8903823.] and magnets placed at the end of the scope or at the end of orogastric tubes. [Yamauchi K, Kobayashi T, Shinomiya T, Fujiwara D, Ito W, Onoda T, Yozai K, Ishii T, Nanamiya W, Sumiyoshi R, Ono T, Tamai M, Yamane Y, Suzaki N. Device for the removal of button batteries. "Intern Med." 2001 Jan;40(1):9-13. PMID 11201377] Some techniques have been described that use foley catheters to trap objects, or use two snares to orient foreign bodies.

ee also

*Bezoar
*Schatzki ring

References

External links

* [http://rad.usuhs.edu/medpix/medpix.html?mode=single&recnum=1175 Esophageal Coin] MedPix Topic