Endoscopic foreign body retrieval

Last updated
Endoscopic foreign body retrieval
Foreign Body.jpg
Endoscopic still of gastric foreign body (toothbrush)
Specialty Gastroenterology

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. [1] It is of particular importance with children, [2] people with mental illness, [3] and prison inmates [4] as these groups have a high rate of foreign body ingestion.

Contents

Commonly swallowed objects include coins, buttons, batteries, and small bones (such as fish bones), [1] but can include more complex objects, such as eyeglasses, [5] spoons, [6] and toothbrushes [5] (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. [1] [7]

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. [1]

Foreign bodies should be removed from the esophagus within 24 hours of ingestion because of a high risk of complication. [8]

Non-invasive testing

Chest X-ray showing a Canadian dollar coin in the esophagus of a young child Foreign body aspiration.jpg
Chest X-ray showing a Canadian dollar coin in the esophagus of a young child

Prior to undertaking endoscopy, attempts should be made to locate the foreign body with x-rays or other non-invasive techniques. [1] For radio-opaque objects, x-rays of the neck, chest and abdomen can be used to locate the foreign body and assist endoscopy. [9] Alternative approaches, including the use of metal detectors, have also been described. [10]

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. [1]

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. [11]

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, [12] snares, and oval loops that can be retracted from outside the gastroscope to lasso objects, [13] as well as Roth baskets (mesh nets that can be closed to trap small objects), [14] and magnets placed at the end of the scope or at the end of orogastric tubes. [12] [15] Some techniques have been described that use foley catheters to trap objects, or use two snares to orient foreign bodies. [6]

Alternative methods

In veterinary medicine or when there is no endoscope available to extract foreign bodies economically without operation the Hartmann alligator forceps can be used. [16]

See also

Related Research Articles

<span class="mw-page-title-main">Gastroenterology</span> Branch of medicine focused on the digestive system and its disorders

Gastroenterology is the branch of medicine focused on the digestive system and its disorders. The digestive system consists of the gastrointestinal tract, sometimes referred to as the GI tract, which includes the esophagus, stomach, small intestine and large intestine as well as the accessory organs of digestion which include the pancreas, gallbladder, and liver.

<span class="mw-page-title-main">Barrett's esophagus</span> Precancerous tissue formation in the esophagus

Barrett's esophagus is a condition in which there is an abnormal (metaplastic) change in the mucosal cells lining the lower portion of the esophagus, from stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells that are normally present only in the small intestine and large intestine. This change is considered to be a premalignant condition because of its potential to further transition to esophageal adenocarcinoma, an often-deadly cancer.

Coffee ground vomitus refers to a particular appearance of vomit. Within organic heme molecules of red blood cells is the element iron, which oxidizes following exposure to gastric acid. This reaction causes the vomitus to look like ground coffee.

<span class="mw-page-title-main">Esophagogastroduodenoscopy</span> Diagnostic endoscopic procedure

Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure. However, a sore throat is common.

<span class="mw-page-title-main">Rectal foreign body</span> Large bodies found in the rectum in medical context

Rectal foreign bodies are large foreign items found in the rectum that can be assumed to have been inserted through the anus, rather than reaching the rectum via the mouth and gastrointestinal tract. It can be of clinical relevance if the patient cannot remove it the way they intended. Smaller, ingested foreign bodies, such as bones eaten with food, can sometimes be found stuck in the rectum upon X-ray and are rarely of clinical relevance.

<span class="mw-page-title-main">Foreign body</span> Object originating outside the body of an organism

A foreign body (FB) is any object originating outside the body of an organism. In machinery, it can mean any unwanted intruding object.

Stretta is a minimally invasive endoscopic procedure for the treatment of gastroesophageal reflux disease (GERD) that delivers radiofrequency energy in the form of electromagnetic waves through electrodes at the end of a catheter to the lower esophageal sphincter (LES) and the gastric cardia – the region of the stomach just below the LES. The energy heats the tissue, ultimately causing it to swell and stiffen; the way this works was not understood as of 2015, but it was thought that perhaps the heat causes local inflammation, collagen deposition and muscular thickening of the LES and that it may disrupt the nerves there.

<span class="mw-page-title-main">Self-expandable metallic stent</span> Medical intervention

A self-expandable metallic stent is a metallic tube, or stent that holds open a structure in the gastrointestinal tract to allow the passage of food, chyme, stool, or other secretions related to digestion. Surgeons insert SEMS by endoscopy, inserting a fibre optic camera—either through the mouth or colon—to reach an area of narrowing. As such, it is termed an endoprosthesis. SEMS can also be inserted using fluoroscopy where the surgeon uses an X-ray image to guide insertion, or as an adjunct to endoscopy.

<span class="mw-page-title-main">Endoclip</span>

An endoclip is a metallic mechanical device used in endoscopy in order to close two mucosal surfaces without the need for surgery and suturing. Its function is similar to a suture in gross surgical applications, as it is used to join together two disjointed surfaces, but, can be applied through the channel of an endoscope under direct visualization. Endoclips have found use in treating gastrointestinal bleeding, in preventing bleeding after therapeutic procedures such as polypectomy, and in closing gastrointestinal perforations. Many forms of endoclips exist of different shapes and sizes, including two and three prong devices, which can be administered using single use and reloadable systems, and may or may not open and close to facilitate placement.

<span class="mw-page-title-main">Esophageal food bolus obstruction</span> Blockage of the esophagus by an ingested foreign body

An esophageal food bolus obstruction is a medical emergency caused by the obstruction of the esophagus by an ingested foreign body.

<span class="mw-page-title-main">Foreign body in alimentary tract</span> Medical condition

One of the most common locations for a foreign body is the alimentary tract. It is possible for foreign bodies to enter the tract either from the mouth, or from the rectum.

Therapeutic endoscopy is the medical term for an endoscopic procedure during which treatment is carried out via the endoscope. This contrasts with diagnostic endoscopy, where the aim of the procedure is purely to visualize a part of the gastrointestinal, respiratory or urinary tract in order to aid diagnosis. In practice, a procedure which starts as a diagnostic endoscopy may become a therapeutic endoscopy depending on the findings, such as in cases of upper gastrointestinal bleeding, or the finding of polyps during colonoscopy.

<span class="mw-page-title-main">Chromoendoscopy</span> Gastrointestinal endoscopic imaging with dyes

Chromoendoscopy is a medical procedure wherein dyes are instilled into the gastrointestinal tract at the time of visualization with fibre-optic endoscopy. The purpose of chromoendoscopy is chiefly to enhance the characterization of tissues, although dyes may be used for other functional purposes. The detail achieved with chromoendoscopy can often allow for identification of the tissue type or pathology based upon the pattern uncovered.

Blair S. Lewis, M.D., F.A.C.P., F.A.C.G., is an American board-certified gastroenterologist and Clinical Professor of Medicine at the Mount Sinai School of Medicine. Lewis is a specialist in the field of gastrointestinal endoscopy and was the primary investigator for the first clinical trial of capsule endoscopy for the small intestine and also the first clinical trial of capsule endoscopy for the colon.

A phytobezoar is a type of bezoar, or trapped mass in the gastrointestinal system, that consists of components of indigestible plant material, such as fibres, skins and seeds. While phytobezoars may be discovered incidentally on barium x-ray or endoscopic testing of the stomach, individuals with phytobezoars may develop symptoms: nausea, vomiting, gastric outlet obstruction, perforation, abdominal pain, and bleeding have been reported. Conditions that lead to decreased motility in the stomach (gastroparesis) and surgeries on the stomach are associated with the development of phytobezoars. A specific type of phytobezoar, termed a diospyrobezoar, is associated with ingestion of unripe persimmons, which contain a soluble tannin called shibuol that polymerizes into a coagulative cellulose-protein compound in the acid environment of the stomach, to form the bezoar. In addition to their presence in human stomachs, phytobezoars have been documented in the stomachs of slaughtered plant-eating animals.

Endoscopic submucosal dissection (ESD) is an advanced surgical procedure using endoscopy to remove gastrointestinal tumors that have not entered the muscle layer. ESD may be done in the esophagus, stomach or colon. Application of endoscopic resection (ER) to gastrointestinal (GI) neoplasms is limited to lesions with no risk of nodal metastasis. Either polypectomy or endoscopic mucosal resection (EMR) is beneficial for patients because of its low level of invasiveness. However, to ensure the curative potential of these treatment modalities, accurate histopathologic assessment of the resected specimens is essential because the depth of invasion and lymphovascular infiltration of the tumor is associated with considerable risk for lymph node metastasis. For accurate assessment of the appropriateness of the therapy, en bloc resection is more desirable than piecemeal resection. For a reliable en bloc resection of GI neoplasms, a new method of ER called endoscopic submucosal dissection (ESD) has been developed.

Caustic ingestion occurs when someone accidentally or deliberately ingests a caustic or corrosive substance. Depending on the nature of the substance, the duration of exposure and other factors it can lead to varying degrees of damage to the oral mucosa, the esophagus, and the lining of the stomach.

In medicine, endoscopic sleeve gastroplasty (ESG) is a minimally-invasive, non-surgical (incisionless), endoscopic weight loss procedure that is part of the field of endoscopic bariatric therapies. To perform ESG, a physician sutures a patient’s stomach into a narrower, smaller tube-like configuration. The result is a more restricted stomach that forces patients to feel fuller sooner, eating fewer calories, which facilitates weight loss.

Buried bumper syndrome (BBS) is a condition that affects feeding tubes placed into the stomach through the abdominal wall. Gastrostomy tubes include an internal bumper, which secures the inner portion of the tube inside the stomach, and external bumper, which secures the outer portion of the tube and opposes the abdomen. Buried bumper syndrome occurs when the internal bumper of a gastrostomy tube erodes into the wall of the stomach. The internal bumper may become entirely buried within the fistulous tract. The main causative factor is excessive tightening of the external bumper, leading to increased pressure of the internal bumper on the wall of the stomach. Additional risk factors include: obesity, weight gain, malnutrition, corticosteroid therapy, and poor wound healing.

Esophageal inlet patch or heterotopic gastric mucosa of the upper esophagus or gastric inlet patch is one or more areas of tissue resembling stomach tissue which is found in the upper portion of the esophagus.

References

  1. 1 2 3 4 5 6 Eisen, GM; Baron, TH; Dominitz, JA; Faigel, DO; Goldstein, JL; Johanson, JF; Mallery, JS; Raddawi, HM; et al. (2002). "Guideline for the management of ingested foreign bodies". Gastrointestinal Endoscopy. 55 (7): 802–6. doi:10.1016/S0016-5107(02)70407-0. PMID   12024131.{{cite journal}}: CS1 maint: numeric names: authors list (link)
  2. ↑ Kay, M; Wyllie, R (2005). "Pediatric foreign bodies and their management". Current Gastroenterology Reports. 7 (3): 212–8. doi:10.1007/s11894-005-0037-6. PMID   15913481. S2CID   21800189.
  3. ↑ Webb, WA (1995). "Management of foreign bodies of the upper gastrointestinal tract: update". Gastrointestinal Endoscopy. 41 (1): 39–51. doi:10.1016/S0016-5107(95)70274-1. PMID   7698623.
  4. ↑ O'Sullivan, S. T.; Reardon, C. M.; McGreal, G. T.; Hehir, D. J.; Kirwan, W. O.; Brady, M. P. (1996). "Deliberate ingestion of foreign bodies by institutionalised psychiatric hospital patients and prison inmates". Irish Journal of Medical Science. 165 (4): 294–6. doi:10.1007/BF02943095. PMID   8990660. S2CID   4232154.
  5. 1 2 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.
  6. 1 2 Aoyagi, K; Maeda, K; Morita, I; Eguchi, K; Nishimura, H; Sakisaka, S (2003). "Endoscopic removal of a spoon from the stomach with a double-snare and balloon". Gastrointestinal Endoscopy. 57 (7): 990–1. doi:10.1016/S0016-5107(03)70044-3. PMID   12776067.
  7. ↑ Nandi, P; Ong, GB (1978). "Foreign body in the oesophagus: review of 2394 cases". The British Journal of Surgery. 65 (1): 5–9. doi:10.1002/bjs.1800650103. PMID   623968. S2CID   43510040.
  8. ↑ Chaikhouni, A; Kratz, JM; Crawford, FA (1985). "Foreign bodies of the esophagus". The American Surgeon. 51 (4): 173–9. PMID   3985482.
  9. ↑ Lane, JE; Boltri, JM (2005). "Imaging gastric pennies in children". Emergency Radiology. 11 (3): 180–2. doi:10.1007/s10140-004-0372-1. PMID   16028326. S2CID   27333104.
  10. ↑ Ramlakhan, SL; Burke, DP; Gilchrist, J (2006). "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". Emergency Medicine Journal. 23 (6): 456–60. doi:10.1136/emj.2005.029553. PMC   2564343 . PMID   16714508.
  11. ↑ Smith, M. T.; Wong, R. K. (2006). "Esophageal foreign bodies: Types and techniques for removal". Current Treatment Options in Gastroenterology. 9 (1): 75–84. doi:10.1007/s11938-006-0026-3. PMID   16423316. S2CID   23798796.
  12. 1 2 Seo, JK (1999). "Endoscopic management of gastrointestinal foreign bodies in children". Indian Journal of Pediatrics. 66 (1 Suppl): S75–80. PMID   11132474.
  13. ↑ Chen, SC; Yu, SC; Yuan, RH; Chang, KJ (1997). "Endoscopic removal of a large gastric metallic watch with a polypectomy snare loop". Endoscopy. 29 (9): S55–6. doi: 10.1055/s-2007-1004333 . PMID   9476781.
  14. ↑ Neustater, B; Barkin, JS (1996). "Extraction of an esophageal food impaction with a Roth retrieval net". Gastrointestinal Endoscopy. 43 (1): 66–7. doi:10.1016/s0016-5107(96)70265-1. PMID   8903823.
  15. ↑ Yamauchi, K; Kobayashi, T; Shinomiya, T; Fujiwara, D; Ito, W; Onoda, T; Yozai, K; Ishii, T; et al. (2001). "Device for the removal of button batteries". Internal Medicine (Tokyo, Japan). 40 (1): 9–13. doi: 10.2169/internalmedicine.40.9 . PMID   11201377.
  16. ↑ Barsotti, Giovanni; Mannucci, Tommaso; Citi, Simonetta (December 2019). "Ultrasonography-guided removal of plant-based foreign bodies from the lacrimal sac in four dogs". BMC Veterinary Research. 15 (1). doi: 10.1186/s12917-019-1817-9 .
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.