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

Esophagus

The esophagus is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. During swallowing, food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach...

, stomach

Stomach

The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...

 and duodenum

Duodenum

The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms anterior intestine or proximal intestine may be used instead of duodenum...

 by endoscopic

Endoscopy

Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...

 techniques. It does not involve surgery

Surgery

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

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

Esophagogastroduodenoscopy

For other expansions of the initialism "OGD", see the disambiguation page.In medicine , esophagogastroduodenoscopy is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum...

 for grasping foreign bodies, manipulating them, and removing them while protecting the esophagus and trachea

Vertebrate trachea

In tetrapod anatomy the trachea, or windpipe, is a tube that connects the pharynx or larynx to the lungs, allowing the passage of air. It is lined with pseudostratified ciliated columnar epithelium cells with goblet cells that produce mucus...

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

Mental illness

A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...

, and prison

Prison

A prison is a place in which people are physically confined and, usually, deprived of a range of personal freedoms. Imprisonment or incarceration is a legal penalty that may be imposed by the state for the commission of a crime...

 inmates as these groups have a high rate of foreign body ingestion.

Commonly swallowed objects include coin

Coin

A coin is a piece of hard material that is standardized in weight, is produced in large quantities in order to facilitate trade, and primarily can be used as a legal tender token for commerce in the designated country, region, or territory....

s, button

Button

In modern clothing and fashion design, a button is a small fastener, most commonly made of plastic, but also frequently of seashell, which secures two pieces of fabric together. In archaeology, a button can be a significant artifact. In the applied arts and in craft, a button can be an example of...

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

Spoons

Spoons, also known as Pig and Tongue, is a fast-paced game of matching and bluffing family of card games of the Crazy Eights group, closely related to Craits played with an ordinary pack of playing cards and several ordinary kitchen spoons or various other objects...

, and toothbrush

Toothbrush

The toothbrush is an oral hygiene instrument used to clean the teeth and gums that consists of a head of tightly clustered bristles mounted on a handle, which facilitates the cleansing of hard-to-reach areas of the mouth. Toothpaste, which often contains fluoride, is commonly used in conjunction...

es (see image).

Indications and contraindications

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

Medical history

The medical history or anamnesis of a patient is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information , with the aim of obtaining information useful in formulating a diagnosis and providing...

 of ingestion, either due to age

Ageing

Ageing or aging is the accumulation of changes in a person over time. Ageing in humans refers to a multidimensional process of physical, psychological, and social change. Some dimensions of ageing grow and expand over time, while others decline...

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

Symptom

A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...

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

Saliva

Saliva , referred to in various contexts as spit, spittle, drivel, drool, or slobber, is the watery substance produced in the mouths of humans and most other animals. Saliva is a component of oral fluid. In mammals, saliva is produced in and secreted from the three pairs of major salivary glands,...

, neck tenderness, regurgitation

Vomiting

Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...

 of food, stridor

Stridor

Stridor is a high pitched wheezing sound resulting from turbulent air flow in the upper airway. Stridor is a physical sign which is produced by narrow or obstructed airway path. It can be inspiratory, expiratory or biphasic . Inspiratory stridor is common...

 and shortness of breath

Dyspnea

Dyspnea , shortness of breath , or air hunger, is the subjective symptom of breathlessness.It is a normal symptom of heavy exertion but becomes pathological if it occurs in unexpected situations...

 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

Boerhaave syndrome

Esophageal rupture is rupture of the esophageal wall due to vomiting. 56% of esophageal perforations are iatrogenic, usually due to medical instrumentation such as an endoscopy or paraesophageal surgery...

 or mediastinitis

Mediastinitis

Mediastinitis is inflammation of the tissues in the mid-chest, or mediastinum. It can be either acute or chronic.Acute mediastinitis is usually bacterial and due to rupture of organs in the mediastinum. As the infection can progress rapidly, this is considered a serious condition...

 (inflammation of structures around the esophagus), and for narcotic

Narcotic

The term narcotic originally referred medically to any psychoactive compound with any sleep-inducing properties. In the United States of America it has since become associated with opioids, commonly morphine and heroin and their derivatives, such as hydrocodone. The term is, today, imprecisely...

-containing bags or condom

Condom

A condom is a barrier device most commonly used during sexual intercourse to reduce the probability of pregnancy and spreading sexually transmitted diseases . It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner...

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

X-ray

X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...

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

Metal detector

A metal detector is a device which responds to metal that may not be readily apparent.The simplest form of a metal detector consists of an oscillator producing an alternating current that passes through a coil producing an alternating magnetic field...

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

Endoscopy

Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...

 retrieval involves the use of a gastroscope or an optic fiber charge-coupled device

Charge-coupled device

A charge-coupled device is a device for the movement of electrical charge, usually from within the device to an area where the charge can be manipulated, for example conversion into a digital value. This is achieved by "shifting" the signals between stages within the device one at a time...

 camera. This instrument is shaped as a long tube, which is inserted through the mouth

Mouth

The mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of 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.

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 forcipes are a handheld, hinged instrument used for grasping and holding objects. Forceps are used when fingers are too large to grasp small objects or when many objects need to be held at one time while the hands are used to perform a task. The term 'forceps' is used almost exclusively...

, which come in varying shapes, sizes and grips, snares, and oval loops that can be retracted from outside the gastroscope to lasso

Lasso

A lasso , also referred to as a lariat, riata, or reata , is a loop of rope that is designed to be thrown around a target and tighten when pulled. It is a well-known tool of the American cowboy. The word is also a verb; to lasso is to successfully throw the loop of rope around something...

 objects, as well as Roth baskets (mesh nets that can be closed to trap small objects), and magnet

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, and attracts or repels other magnets.A permanent magnet is an object...

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

Foley catheter

A Foley catheter is a flexible tube that is often passed through the urethra and into the bladder. The tube has two separated channels, or lumens, running down its length. One lumen is open at both ends, and allows urine to drain out into a collection bag...

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

External links

• Esophageal Coin MedPix Topic