Foreign Body Removal

Foreign body and food bolus impaction is one of the most common emergent endoscopy indications. Adult food impactions are most often meat boluses lodged at a strictured esophagus : eosinophilic esophagitis, peptic strictures, Schatzki rings, and post-fundoplication anatomy are the typical underlying causes. Pediatric and psychiatric ingestions are more diverse: coins, batteries, sharps, magnets, and packets of illicit drugs.

Timing is determined by symptoms and ingestion type. Sharp objects, button batteries (esophageal), and disk magnets require urgent (within 2-6 hours) endoscopy because of perforation, fistula, and pressure-necrosis risk. Food impactions causing complete esophageal obstruction (the patient cannot handle secretions) need urgent intervention. Smooth objects in the stomach and proximal duodenum that have not advanced after 24-48 hours can be retrieved electively.

Technique varies by object. Distal transparent caps and mega-caps allow controlled scope-tip extraction of food boluses and round objects. Tripod and rat-tooth graspers, retrieval nets, polypectomy snares, and overtubes (to protect the airway and esophagus during extraction of sharps) are workhorses of the foreign-body cart. Push-through into the stomach is acceptable for boluses without an underlying tight stricture; otherwise piecemeal retrieval is preferred. Always inspect the underlying mucosa after extraction : the strictured anatomy is the real diagnosis.