Endoscopic removal of entirely embedded esophagus-penetrating foreign bodies (with video).

Abstract

Traditionally, surgery is the only choice for esophageal foreign bodies (FBs) penetrating into the mediastinum or cervical para-esophageal space. Recent progress in endoscopic techniques and devices has made it possible to perform endoscopic procedures in the mediastinum. Here, we describe a novel method to remove the entirely embedded esophagus-penetrating FBs through an endoscopic approach. Patients who underwent endoscopic removal of entirely embedded esophagus-penetrating FBs were prospectively enrolled between December 2018 and June 2020. All procedures were performed by using five major steps: localization of the FB; mucosal incision; wound debridement, myotomy, and FB exposure; FB extraction; and closure of the esophageal wound. A total of five cases of entirely embedded esophagus-penetrating FBs were evaluated, two in children and three in adults. All FBs were successfully removed and extracted using a therapeutic endoscope and a hook knife or a hybrid knife and a grasping forceps as accessories. The average procedure time was 19.0±12.4min (range 10-40min). The major surgical procedure was avoided in all patients. The average length of hospital stay was 3.8±2.5days (range 2-8days). There were no severe short-term adverse events after all procedures. During the 1month and 3months follow-up, no patient developed long-term adverse events including stenosis of the esophagus and fistula formation. Endoscopic approach was a safe and effective way to remove entirely embedded esophagus-penetrating FBs.