Endoscopic foreign body retrieval refers to the removal of ingested objects from the esophagus, stomach and

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by endoscopic techniques. It does not involve

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, 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. It is of particular importance with children, people with

mental illness A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...

, and prison inmates as these groups have a high rate of foreign body ingestion. Commonly swallowed objects include coins, buttons,

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, 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, 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

symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showin ...

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

saliva Saliva (commonly referred to as spit) 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 DNA can be ...

, neck tenderness, regurgitation of food,

stridor Stridor (Latin for "creaking or grating noise") is a high-pitched extra-thoracic 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 pha ...

and shortness of breath 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 (inflammation of structures around the esophagus), and for

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-containing bags or

condom A condom is a sheath-shaped barrier device used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection (STI). There are both male and female condoms. With proper use—and use at every act of in ...

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-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. Alternative approaches, including the use of metal detectors, 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 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 In animal anatomy, the mouth, also known as the oral cavity, or in Latin cavum oris, is the opening through which many animals take in food and issue vocal sounds. It is also the cavity lying at the upper end of the alimentary canal, bounded on ...

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. 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, snares, and oval loops that can be retracted from outside the gastroscope to lasso objects, as well as

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s (mesh nets that can be closed to trap small objects), and magnets placed at the end of the scope or at the end of orogastric tubes. Some techniques have been described that use foley catheters to trap objects, or use two snares to orient foreign bodies.

Alternative methods

In veterinary medicine or when there is no endoscope available to extract foreign bodies economically without operation very often the

Hartmann alligator forceps The Hartmann alligator forceps or Hartmann foreign body forceps, named after the German physician Arthur Hartmann, are medical forceps for removing foreign bodies. It is used in addition to surgery mainly in otorhinolaryngology (ENT). Their quali ...

is used

References

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External links