Novel Use of the Soehendra® Stent Extractor in Esophageal Foreign Body Removal

Abstract

Purpose: Cases of esophageal foreign body (FB) impaction are common. The majority are safely and effectively managed using standard endoscopy tools, such as forceps and snares. For challenging cases, non-standard methods, such as aggressive endoscopy, enzymatic digestion and hormonal therapy, can cause complications like bleeding and perforation. We report a 36 y/o Caucasian female with a history of dysphagia who presented with FB impaction after taking a multivitamin called the “Sniffle Kicker.” She described a sensation of “blockage” at the suprasternal notch that persisted despite drinking water and inducing vomiting. Glucagon administered in the ER did not alleviate her symptoms. For the past 15 years, she experienced frequent foreign body impactions, but was never endoscoped. The patient underwent upper GI endoscopy. In the distal esophagus there were chunks of pill debris resting above an impacted disk-shaped pill (A,C). Limited success was achieved by trying to break up the pill with alligator forceps and direct suctioning with the endoscope, as the pill had an uneven and hard texture. A 5-French Soehendra® stent extractor, a blunt screw-like device normally used to extract biliary stents, was introduced via the operating channel. It slowly drilled a hole into the center of the pill, eventually traversing the pill (B). An alligator forceps was then used to break up the remaining portions of the pill by biting into this central defect. The foreign body dislodged (D). Biopsies revealed numerous intraepithelial eosinophils indicative of eosinophilia esophagitis (EoE). There were no complications. Food impaction is quite common among patients with EoE. However, esophageal impaction from pill ingestion is rare. Endoscopic management of blunt, sharp, and meat impactions using a variety of endoscopic tools are well described. We believe this is the first report describing the use of the Soehendra stent extractor to relieve an esophageal impaction.Figure: [1807] Figure A: Pill firmly lodged in distal esophagus. Figure B: Status post drilling into pill with Soehendra stent extractor. Figure C: Using alligator forceps and central defect to break up the pill. Figure D: Esophagus after the debris was cleared away.