Endoscopic foreign body retrieval refers to the removal of ingested objects from the

esophagus The esophagus ( American English) or oesophagus (British English; both ), non-technically known also as the food pipe or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to ...

stomach The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...

and duodenum by

endoscopic An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...

techniques. It does not involve surgery, but rather encompasses a variety of techniques employed through the

gastroscope 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 considere ...

for grasping

foreign bodies A foreign body (FB) is any object originating outside the body of an organism. In machinery, it can mean any unwanted intruding object. Most references to foreign bodies involve propulsion through natural orifices into hollow organs. Foreign bo ...

, manipulating them, and removing them while protecting the esophagus and

trachea The trachea, also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air- breathing animals with lungs. The trachea extends from the ...

. It is of particular importance with children, people with mental illness, and

prison A prison, also known as a jail, gaol (dated, standard English, Australian, and historically in Canada), penitentiary (American English and Canadian English), detention center (or detention centre outside the US), correction center, corre ...

inmates as these groups have a high rate of foreign body ingestion. Commonly swallowed objects include

coin A coin is a small, flat (usually depending on the country or value), round piece of metal or plastic used primarily as a medium of exchange or legal tender. They are standardized in weight, and produced in large quantities at a mint in order t ...

button A button is a fastener that joins two pieces of fabric together by slipping through a loop or by sliding through a buttonhole. In modern clothing and fashion design, buttons are commonly made of plastic but also may be made of metal, wood, o ...

s, batteries, and small bones (such as fish bones), but can include more complex objects, such as

eyeglasses Glasses, also known as eyeglasses or spectacles, are vision eyewear, with lenses (clear or tinted) mounted in a frame that holds them in front of a person's eyes, typically utilizing a bridge over the nose and hinged arms (known as temples or ...

,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.

spoon A spoon is a utensil consisting of a shallow bowl (also known as a head), oval or round, at the end of a handle. A type of cutlery (sometimes called flatware in the United States), especially as part of a place setting, it is used primarily f ...

s, and

toothbrush A toothbrush is an oral hygiene tool used to clean the teeth, gums, and tongue. It consists of a head of tightly clustered bristles, atop of which toothpaste can be applied, mounted on a handle which facilitates the cleaning of hard-to-reach ar ...

es (see image).

Indications and contraindications

Some patients at risk for foreign body ingestion may not be able to give an accurate

medical history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is information gained by a physician by asking specific questions, either to the patient or to other peo ...

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 Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing di ...

if there is compression of the trachea. 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 Mediastinitis is inflammation of the tissues in the mid-chest, or mediastinum. It can be either acute or chronic. It is thought to be due to four different etiologies: * direct contamination * hematogenous or lymphatic spread * extension of infe ...

(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.

Non-invasive testing

Prior to undertaking endoscopy, attempts should be made to locate the foreign body with

x-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

s 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. Alternative approaches, including the use of

metal detector A metal detector is an instrument that detects the nearby presence of metal. Metal detectors are useful for finding metal objects on the surface, underground, and under water. The unit itself, consist of a control box, and an adjustable shaft, ...

s, have also been described. 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 An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...

retrieval involves the use of a gastroscope or an optic fiber

charge-coupled device A charge-coupled device (CCD) is an integrated circuit containing an array of linked, or coupled, capacitors. Under the control of an external circuit, each capacitor can transfer its electric charge to a neighboring capacitor. CCD sensors are a ...

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 Procedural sedation and analgesia (PSA) is a technique in which a sedating/dissociative medication is given, usually along with an analgesic medication, in order to perform non-surgical procedures on a patient. The overall goal is to induce a decr ...

. 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. 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 Forceps (plural forceps or considered a plural noun without a singular, often a pair of forceps; the Latin plural ''forcipes'' is no longer recorded in most dictionaries) are a handheld, hinged instrument used for grasping and holding objects. Fo ...

, which come in varying shapes, sizes and grips,

snare SNARE proteins – " SNAP REceptor" – are a large protein family consisting of at least 24 members in yeasts, more than 60 members in mammalian cells, and some numbers in plants. The primary role of SNARE proteins is to mediate vesicle f ...

s, and oval loops that can be retracted from outside the gastroscope to

lasso A lasso ( or ), also called lariat, riata, or reata (all from Castilian, la reata 're-tied rope'), is a loop of rope designed as a restraint to be thrown around a target and tightened when pulled. It is a well-known tool of the Spanish an ...

objects, as well as

Roth basket Roth may refer to: Places Germany * Roth (district), in Bavaria, Germany ** Roth, Bavaria, capital of that district ** Roth (electoral district), a federal electoral district * Rhineland-Palatinate, Germany: ** Roth an der Our, in the district B ...

s (mesh nets that can be closed to trap small objects), and

magnet A magnet is a material or object that produces a magnetic field. This magnetic field is invisible but is responsible for the most notable property of a magnet: a force that pulls on other ferromagnetic materials, such as iron, steel, nicke ...

s placed at the end of the scope or at the end of orogastric tubes. Some techniques have been described that use

foley catheter In urology, a Foley catheter (named for Frederic Foley, who produced the original design in 1929) is a flexible tube that a clinician passes through the urethra and into the bladder to drain urine. It is the most common type of indwelling urinar ...

s to trap objects, or use two snares to orient foreign bodies.

Alternative methods

veterinary medicine Veterinary medicine is the branch of medicine that deals with the prevention, management, diagnosis, and treatment of disease, disorder, and injury in animals. Along with this, it deals with animal rearing, husbandry, breeding, research on nutri ...

or when there is no endoscope available to extract

economically without operation very often the Hartmann alligator forceps is used

References

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External links