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

esophagus The esophagus (American English), oesophagus (British English), or œsophagus (Œ, archaic spelling) (American and British English spelling differences#ae and oe, see spelling difference) all ; : ((o)e)(œ)sophagi or ((o)e)(œ)sophaguses), c ...

stomach The stomach is a muscular, hollow organ in the upper gastrointestinal tract of Human, humans and many other animals, including several invertebrates. The Ancient Greek name for the stomach is ''gaster'' which is used as ''gastric'' in medical t ...

and

duodenum The duodenum is the first section of the small intestine in most vertebrates, including mammals, reptiles, and birds. In mammals, it may be the principal site for iron absorption. The duodenum precedes the jejunum and ileum and is the shortest p ...

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 Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

, but rather encompasses a variety of techniques employed through the gastroscope 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 b ...

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

trachea The trachea (: tracheae or tracheas), 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 animals' lungs. The trachea extends from ...

. It is of particular importance with children, people with

mental illness A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...

, and

prison A prison, also known as a jail, gaol, penitentiary, detention center, correction center, correctional facility, or remand center, is a facility where Prisoner, people are Imprisonment, imprisoned under the authority of the State (polity), state ...

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

coin A coin is a small object, usually round and flat, 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 to facilitate trade. They are most often issued by ...

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, or ...

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

eyeglasses Glasses, also known as eyeglasses (American English), spectacles (Commonwealth English), or colloquially as specs, are Visual perception, vision eyewear with clear or tinted lens (optics), lenses mounted in a frame that holds them in front ...

,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 table setting, place setting, it ...

s, and

toothbrush A toothbrush is a special type of brush used to clean the Human tooth, teeth, gingiva, gums, and tongue. It consists of a head of tightly clustered bristles, atop of which toothpaste can be applied, mounted on a handle (grip), handle which facil ...

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 a set of information the physicians collect over medical interviews. It involves the patient, and ev ...

of ingestion, either due to

age Age or AGE may refer to: Time and its effects * Age, the amount of time someone has been alive or something has existed ** East Asian age reckoning, an Asian system of marking age starting at 1 * Ageing or aging, the process of becoming older ...

or mental illness. It is important that physicians treating these patients recognize the

symptom Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable; symptoms are a person's reported subjective experiences. A sign for example may be a higher or lower temperature ...

s of esophageal foreign body impaction requiring urgent intervention. Most frequently, these include drooling and the inability to swallow

saliva Saliva (commonly referred as spit or drool) is an extracellular fluid produced and secreted by salivary glands in the mouth. In humans, saliva is around 99% water, plus electrolytes, mucus, white blood cells, epithelial cells (from which ...

, neck tenderness, regurgitation of food,

stridor Stridor () is an extra-thoracic high-pitched breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree. It is different from a stertor, which is a noise originating in the pharynx. Stridor is a physical sig ...

and

shortness of breath Shortness of breath (SOB), 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 discomfort that con ...

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 i ...

(inflammation of structures around the esophagus), and for

narcotic The term narcotic (, from ancient Greek ναρκῶ ''narkō'', "I make numb") originally referred medically to any psychoactive compound with numbing or paralyzing properties. In the United States, it has since become associated with opiates ...

-containing bags or

condom A condom is a sheath-shaped Barrier contraception, barrier device used during sexual intercourse to reduce the probability of pregnancy or a Sexually transmitted disease, sexually transmitted infection (STI). There are both external condo ...

s 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 (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...

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. A metal detector consists of a control box, an adjustable shaft, and ...

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 A mouth also referred to as the oral is the body orifice through which many animals ingest food and animal communication#Auditory, vocalize. The body cavity immediately behind the mouth opening, known as the oral cavity (or in Latin), is also t ...

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 (: 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. Forcep ...

, which come in varying shapes, sizes and grips,

snare SNARE proteins – "Soluble NSF attachment protein, SNAP REceptors" – are a large protein family consisting of at least 24 members in yeasts and more than 60 members in mammalian and plant cells. The primary role of SNARE proteins is to m ...

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

lasso A lasso or lazo ( or ), also called reata or la reata in Mexico, and in the United States riata or lariat (from Mexican Spanish lasso for roping cattle), is a loop of rope designed as a restraint to be thrown around a target and tightened when ...

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, nickel, ...

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 is one of many types of urinary catheters (UC). The Foley UC was named after Frederic Foley, who produced the original design in 1929. Foleys are indwelling UC, often referred to as an IDCs (sometimes IDUCs). This dif ...

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, medical diagnosis, diagnosis, and treatment of disease, disorder, and injury in non-human animals. The scope of veterinary medicine is wide, covering all a ...

or when there is no endoscope available to extract

economically without operation the Hartmann alligator forceps can be used.

References

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External links