Endoscopic removal of impacted sharp foreign body in esophagus

Abstract

Background: Most foreign bodies in gastrointestinal tract will pass spontaneously, but 10 to 20% must be removed endoscopically, and approximately 1% require surgery. Especially, ingested foreign body lodged in esophagus increased risk for development of complications, including bleeding, perforation, and death. To prevent these complications, early removal of esophageal foreign body is clinically important and mandatory. But removal of impacted sharp esophageal foreign body can be difficult to manage and life threatening complication as perforation can occur. Therefore surgical intervention generally afford safer approach. The aim of this study is to evaluate the safety and efficacy of endoscopic removal of impacted sharp esophageal foreign body using dilation method with oral side balloon. Material and Methods: Total 12 patients(Male 4, Female 8) with impacted sharp esophageal foreign body underwent endoscopic extraction. The following technique was successfully performed at our institution. We attached oral side balloon(Top Co, Japan) for esophageal variceal sclerotherapy at the distal part of endoscope. Under local anesthesia, inserted endoscope into the esophagus and approximated to near proximal part of esophageal foreign body. Next, oral side balloon was gradually expanded. Dilatation of esophageal lumen with oral side balloon expansion made possible to release impacted sharp foreign body from esophageal wall. Results: 1) The kinds of foreign bodies were fish bone(7 cases) and press-through package(5 cases). 2) Among 12 cases, 4 cases were impacted in the upper esophagus and 8 cases in the mid esophagus. 3) The size of extracted foreign body was 2.3cm-3.3cm (mean 2.7cm). 4) Endoscopic removal was successful in all 12 cases without complications such as perforation. Conclusions: This method using oral side ballon is safe, fast, effective in removing impacted sharp esophageal foreign body avoiding surgery and possible perforation.