Basket extraction of esophageal foreign bodies.

Abstract

When a foreign body becomes lodged in the esophagus, appropriate management depends on the nature of the swallowed object [1]. Prompt endoscopic removal is recommended for a sharp-edged or pointed foreign body because of its potential for esophageal-wall penetration and perforation [2, 3]. Likewise, small disk batteries, such as those used in electronic watches and calculators, should be withdrawn without delay to prevent caustic erosion and perforation of the esophagus [4]. However, if the foreign body has smooth surfaces and is nontoxic, one may justify delaying extraction, because most blunt objects will pass spontaneously without incident [2, 5-7]. To hasten passage into the stomach, a number of noninvasive pharmacologic and mechanical measures have been advocated, such as glucagon to relieve lower esophageal sphincter spasm [1 , 5, 8, 9], sublingual nitroglycerin to eliminate more widespread smooth muscle spasm [51, and carbon dioxide gas to distend the esophagus and push impacted food beyond fixed strictures [9, 1 0]. When noninvasive methods fail to dislodge a blunt object, extraction is required. Currently, most foreign bodies are removed with instruments passed through an endoscope or with a Foley catheter balloon inflated distal to the impaction and withdrawn under fluoroscopic control [1 1 , 12]. We introduce a method for removing blunt foreign bodies from the esophagus using a Dormia-type wire basket under fluoroscopic guidance. The technique is a natural extension of the popular procedure developed by Burhenne [1 3] for removing residual bile duct stones through the T-tube tract. We have found the procedure particularly useful for removing soft food boluses and hard, spherical objects (such as fruit pits) that have become impacted above esophageal strictures.