Removal of Blunt Esophageal Foreign Body Using Foley Catheter in Children

Swallowed Foreign Bodies in Children: Aspects of Management

ObjectiveThis study aimed to determine the factors that affect successful esophageal foreign body (FB) removal using a Foley catheter and to identify methods to increase the success rate.MethodsIn this retrospective, cross-sectional study, we included pediatric patients who presented with esophageal FB impaction that was removed using a Foley catheter in the emergency departments of tertiary care and academic hospitals. We analyzed the effect of the patients’ age, sex, and symptoms; FB type, size, and location; Foley catheter size; complications during FB removal; duration between FB ingestion and removal; operator’s years of training; sedation; success rate of FB removal; endoscopy; and patient’s posture during FB removal on the success of Foley catheter-based FB removal.ResultsOf the 43 patients we enrolled, Foley catheter-based FB removal was successful in 81.4% (35/43) but failed in 18.6% (8/43) of patients; no FB-removal-related complications were reported. There was no significant association between the success rate of Foley catheter-based FB removal and any study variable. A higher number of years in training tended to increase the success rate of Foley catheter-based FB removal, although statistical significance was not achieved.ConclusionChildren’s esophageal FB removal is a practical challenge in the emergency rooms, and using a Foley catheter is associated with a high success rate of the removal and low occurrence of complications. In this study, no single variable was found correlated with the success rate of Foley catheter-based esophageal FB removal in pediatric patients, which may indicate multiple variables interacting with one another to affect the success rate.

Foreign Bodies of the Esophagus: A Two-Year Prospective Study

Esophageal foreign body could cause stridor. Stridor may be persistent due to residual foreign body even after removal of esophageal foreign body. We describe a case of a 10-month-old boy who experienced persistent stridor after initial removal of esophageal foreign body. He had been brought to the emergency department, and a foreign body had been removed by rigid bronchoscopy. Nevertheless, he had persistent stridor. A computed tomography (CT) scan revealed residual foreign body with associated calcification in the prevertebral soft tissue (C3-C5 level). He has been on surgical observation with foreign body in situ. Key Words: Infant; Esophagus; Foreign Bodies; Respiratory Sounds

Continued controversy over the role of fluoroscopically guided Foley catheter removal of esophageal foreign bodies has limited the use of this technique despite its significant economic advantages. We reviewed our experience for the safety, efficacy, and applicability of this technique with pediatric patients who had swallowed coins. We retrospectively reviewed 10 years of experience with pediatric patients who had undergone fluoroscopically guided Foley catheter removal of coins. All the pediatric patients with a suspected esophageal foreign body were first evaluated by plain film radiography. Foley catheter extraction was attempted when a radiopaque coin was seen and the patient lacked signs of significant esophageal edema resulting in tracheal compromise. During the 10 years covered by our review, 14 pediatric radiologists with specific training in the Foley catheter technique were involved in such removals. A separate review (of consecutive pediatric patients who had a history of or symptoms suggesting ingestion of a foreign body) focused on the percentage of these patients in which the Foley catheter technique was used. Of the 337 coin extractions attempted using a Foley catheter, coin extraction was successful in 322 (96%) of 337 patients. No complications were encountered. Our focused review found 422 consecutive patients who had undergone radiography to rule out foreign bodies. A radiopaque object was found in 249 (59%) of 422 patients. Of these 249 objects, 208 (84%) were ingested coins. Of 208 coins, 123 (59%) were retained in the esophagus; of these 123 coins retained in the esophagus, 116 (94%) were amenable to fluoroscopically guided Foley catheter extraction. Fluoroscopically guided Foley catheter extraction of retained coins in pediatric patients who lack evidence of significant esophageal edema causing tracheal compromise is a safe and efficacious technique. It should be considered the technique of choice for such extractions.

BackgroundThe impaction of an esophageal foreign body is an urgent situation requiring emergency intervention. This retrospective study from a single center in China aimed to compare endoscopy alone with surgery converted from endoscopy for the removal of esophageal foreign bodies in adults.Material/MethodsA total of 252 patients with esophageal foreign bodies were divided into 3 groups based on the treatment received: endoscopy, surgery converted from endoscopy, or surgery only. Patients’ clinical and demographic data were retrospectively reviewed and analyzed.ResultsThe diameter of the foreign bodies in patients treated by surgery converted from endoscopy was larger than that of those treated by simple endoscopy (5.2 cm vs 2.7 cm, P=0.0003). The cervical or upper thoracic esophagus was the most common site of foreign body impaction treated by surgery converted from endoscopy, while the foreign bodies removed by simple endoscopy were frequently lodged at the middle thoracic esophagus (P=0.021). Bone-related foreign bodies and dentures were most likely impacted in patients treated with surgery converted from endoscopy. The factors influencing the choice of treatment included foreign body maximal diameter and location.ConclusionsLarger foreign bodies that were found in the cervical or upper thoracic esophagus were associated with failed endoscopic removal and required surgical removal. Irregularly shaped or sharp foreign bodies, including dentures and fishbones, required surgical removal. These findings may guide future decisions of first-line approaches for the removal of esophageal foreign bodies.

Introduction: Current ASGE guidelines recommend emergent removal of esophageal food bolus impactions and foreign bodies though this is two star (low quality evidence) guideline and further research has been recommended in this area. We aim to study the differences in outcomes based on early versus late esophagogastroduodenoscopy (EGD) among patients presenting with a foreign body in esophagus using a large national inpatient sample database. Methods: The National Inpatient Sample (NIS) databases (2002-2011) is the largest all payer inpatient care database, containing around 5 to 8 million hospitalizations from approximately 1000 hospitals in the USA. The patients presented with foreign body in esophagus and EGDs were identified using the ICD-9 codes. Early EGD was defined as being performed on the day of admission. Various outcomes such as inpatient mortality, acute respiratory failure (ARF)/aspiration pneumonia (AP), iatrogenic pneumothorax, endotracheal intubation, length of stay (LOS), and total hospitalization cost were evaluated. Multivariate logistic regression analysis adjusted for age, sex, race, complications and Elixhauser comorbidities was used to identify independent predictors of inpatient mortality. Results: Our study included 21,475 hospitalizations related to a foreign body in esophagus. The mean age of the study population was 51.2 years with 71.8% white and 54.9% male. Overall 55.8% of hospitalizations had an early EGD. There was a significantly lower rate of ARF and AP requiring endotracheal intubation >96 hours among hospitalizations with early EGD (ARF/AP: 9.2% vs 12.6%, p < .001; intubation: 0.7% vs 1.3%, p < .001). Hospitalizations with early EGD had a significantly lower rate of inpatient mortality. (0.6% vs 1.9%, p < .001). Multivariate logistic model identified age, delay in EGD, requiring endotracheal intubation, ARF/AP and having multiple comorbid conditions as independent risk factors associated with inpatient mortality (Table 1). Overall hospitalization mean LOS and financial charges were significantly lower among hospitalizations with early EGD. (LOS: 2.0 vs 4.2 days, p < .001; financial cost: $16,634 vs $24,390, p < .001).Table 1: Independent risk factors associated with inpatient mortality among hospitalizations with foreign body in esophagusConclusion: Our study showed significantly reduced finalcial burden, and lower rates of complications and inpatient mortality related to foreign body in esophagus among individuals who undergo early EGD. Our study adds high quality evidence to current ASGE guideline by utilizing a large nationally representative hospitalization sample.

To assess complication rate, risk factors for complications and outcome in dogs with oesophageal and gastric endoscopic foreign body (FB) removal. Medical records of 102 dogs undergoing endoscopic removal of oesophageal and/or gastric FBs from March 2001 to November 2006 were retrospectively reviewed. All owners were contacted by telephone to provide follow-up information. West Highland white terriers, Yorkshire terriers and Bernese mountain dogs were over-represented compared to the hospital population. Endoscopy alone was successful in 92/102 dogs (90.2 per cent), whereas gastrotomy (but no oesophagotomy) was required in 10 dogs (9.8 per cent). Complications in 13/102 dogs (12.7 per cent) were perforation (8), oesophageal stricture (1), oesophageal diverticula (1), perioesophageal abscess (1), pneumothorax and pleural effusion (1) and respiratory arrest (1). Six dogs (all weighing <10 kg) had complications resulting in death or euthanasia. Bone FBs, bodyweight of less than 10 kg, and oesophageal or gastric FB in place for more than three days were significant risk factors for complications. Of the dogs available for follow-up (75/96), 92 per cent had no complications after discharge. Endoscopic FB removal is associated with a low overall complication rate with bone FBs and bodyweight of less than 10 kg as significant risk factors.

Introduction:The typical manifestations of patients with a trisomy 21 syndrome are mental retardation and anatomical deformities of face and neck. In the available literature, all case reports regarding anesthetic management of mentally retarded patients have focused on elective surgeries. There is no report regarding anesthetic management of mentally retarded patients undergoing emergency surgery.Patient concerns:A 47-year-old woman with a mental retardation grade 2 by trisomy 21 syndrome suffered from an esophageal foreign body for 3 days and needed emergency removal of esophageal foreign body. The patient had a poor cooperation and obvious anatomical abnormalities of head and neck.Diagnoses:Difficult anesthesia and airway managements for emergency removal of esophageal foreign bodies in a trisomy 21patients with mental retardation and predicted difficult airways.Interventions:Combined use of an intubating supraglottic airway and the flexible bronchoscope-guided intubation after intravenous anesthesia induction.Outcomes:Effective airway was safely established and an esophageal foreign body was successfully removed by rigid esophagoscopy under anesthesia. The patient recovered smoothly without any complication.Lessons subsections as per style:When general anesthesia and emergency airway management are required in the patients with mental retardation and predicted difficult airways, a combination of the supraglottic airway and the flexible bronchoscope maybe a safe and useful choice for airway control.

To determine the incidence and types of complications associated with oesophageal foreign body (FB) removal in dogs, as well as to evaluate potential risk factors for the development of complications. Clinical records were searched within Animal Emergency Service and Veterinary Specialist Services databases between July 2001 and March 2017. Data were collected regarding signalment, FB type, method of removal, medical management and complications. Follow-up records from the referring veterinarian were then obtained by either phone call or email. A total of 349 FB cases were reviewed. The majority of FBs were bones (77.4%), with Staffordshire Bull Terriers (12.3%) and West Highland White Terriers (9.8%) the most common breeds seen. Complications at the time of FB removal occurred in 20 cases (5.9%), with 14 cases of perforation. Persistent gastrointestinal signs were reported in 4.7% of cases within the initial 72-h period following FB removal and 11.9% cases outside this time period. Respiratory signs such as dyspnoea and coughing were also reported in 8 cases (2.3%), all of which occurred within 72 h after FB removal. Follow-up of at least 1 month was available in 151 cases. Delayed complications occurred in 11 cases (7.3%), with stricture occurring in 4 cases (2.6%); 16 animals were either euthanased (n = 14) or died (n = 2) post-FB removal, resulting in a case fatality rate of 4.6%. Use of antacid medications and FB type did not have a statistically significant relationship with complications following FB removal.

Swallowed objects may be true esophageal foreign bodies, such as coins, dentures, press-through-pack etc., and several methods has been used for the removal of esophageal foreign bodies. We experienced a case of a successful Fogarty occlusion catheter extraction of a piece of glass from the upper thoracic esophagus.The patient was a 34-year-old male, who swallowed broken pieces of a whisky bottle for suicide. The thoracic CT and esophageal fluoroscope showed the shadow of a foreign body in the upper thoracic esophagus, and surgery was performed under general anesthesia. We tried to remove the foreign body with a rigid esophagoscope and forceps, but it was firmly affixed to the esophageal wall. We inserted a Foley catheter over the foreign body with a pair of forceps, but it was too short and allowed insufficient expansion of the balloon for removing the foreign body. Therefore, we inserted a Fogarty occlusion catheter over the foreign body with the forceps, inflated the balloon on the gastric side, and drew out the catheter together with the foreign body. No complications occurred.We disccussed the usefulness of a Fogarty occlusion catheter for the removal of an esophageal foreign body in this paper.

Impacted esophageal foreign body in children may pose a challenging clinical scenario to the gastroenterologists.Early recognition and treatment is imperative as the complications can be life threatening.The Foley catheter method of foreign body extraction has been used on some patients, but endoscopy remains the treatment modality of choice.Here we report an interesting case of a child with impacted stone in the esophagus in whom a combined endoscopic-Foley catheter technique was successfully applied to extract the impacted foreign body

Upper esophageal foreign body impaction is a common clinical presentation and often requires medical attention. The most common foreign bodies encountered in the adult population are food-related, e.g., steak pieces and meat bones. Endoscopic interventions are indicated when the foreign objects fail to pass spontaneously. The standard methods to remove these foreign bodies include push technique and retrieval methods using various endoscopic instruments. However, we report a unique method that was used to remove a large upper esophageal impacted foreign body refractory to removal by standard procedures.

Background: Variety of foreign bodies may enter the digestive tract accidentally. Many pass spontaneously, but some become impacted, causing symptoms of obstruction. The cricopharynx and esophagus are the most common site of impaction. Nearly, all impacted objects can be removed endoscopically but, occasionally open surgery may be required. Objectives: This study was conducted on 228 patients with the aim to describe age-sex incidence, socioeconomic and geographical distribution, types of foreign body ingested and management strategy. Methods: Retrospective study was conducted in tertiary care hospital of Central India on 228 patients who had undergone rigid endoscopic removal of digestive tract foreign body from January 2007 to January 2014. Results: Foreign body ingestion was found most commonly in the age group of 1-3 year. (133; 58.33%) with male predominance. 180 patients (78.94%) belonged to lower socioeconomic status. Out of them 160 patients came from rural areas. Definitive history was found in (212; 92.98%) patients with dysphagia to solid as the most common presenting symptom. Most of the foreign bodies were detected by plain X-rays (203; 89.03%). Coin was found to be the most commonly ingested foreign body (67.54%). Cricopharynx was the most common site of impaction (86.4%). Rigid endoscopic removal under general anesthesia was successful in all 228 patients. Conclusions: Higher incidence of ingestion of foreign body is in toddlers. The most common site of lodgement was at the cricopharynx and upper third of esophagus. Early detection and rigid endoscopic removal can prevent from morbidity associated with the complications of foreign body impaction. 1. Webb WA. Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc. 1995;41:39-51. 2. G. Paul Digoy. Diagnosis and management of upper aerodigestive tract foreign bodies. OCNA. 2008;41:485-96. 3. Prakash Adhikari, Bikesh Lal Shrestha, Dharma K. Baskota, Bimal K. Sinha. Accidental foreign body ingestion: analysis of 163 cases. Arch Otolaryngol. 2007;11(3):267-70. 4. Palta R, Sahota A, Bemarki A, Salama P, Simpson N, Laine L. Foreign-body ingestion: characteristics and outcomes in lower socioeconomic population with predominantly intentional ingestion. Gastrointest Endosc. 2009;69:426-33. 5. Litivitz EL, Schmitz BF. Ingestions of cylindrical and button batteries: an analysis of 2382 cases. Pediatrics. 1992;89:747-57. 6. Hachimi-Idrissi S, Come L, Vandenpias Y. Management of ingested foreign bodies in childhood: our experience and review of literature. Eur J Emerg Med. 1998;5:319-23. 7. Naid Dehghani. Ingested foreign bodies in children: BC children’s hospital emergency room protocol. BC Med J. 2008 June;5(5):257-62. 8. ASGE Standards of Practice Committee, Steven O. Ikenberry, Terry L. Jue, M. Anderson, V. Appalaneni, S. Banerjee, et al. Management of ingested foreign bodies and food impactions. Gastrointestin Endosc. 2011;73(6):1085-91. 9. Faigel DO, Stotland BR, Kochman ML, Hoops T, Judge T, Kroser J, et al. Device choice and experience level in endoscopic foreign object retrieval: an in vivo study. Gastrointestin Endosc. 1997;45:490-2. 10. Nixon GW. Foley catheter method of esophageal foreign body removal: extension of applications. Am J Radiol. 1979;132:441-2. 11. Bonadio WA, Jona JZ, Glicklich M, Cohen R. Esophageal Bougie technique for coin ingestion in children. J Pediatr Surg. 1988;23:917-8. 12. Chu KM, Choi HK, Tuen HH, Law SY, Branicki FJ, Wong J. A Prospective randomized trial comparing the use of the flexible gastroscope versus the broncoscope in the management of foreign body ingestion. Gastrointest Endosc. 1998;47:23-7. 13. Ferruci TJ, Long JA. Radiographic treatment of esophageal food impaction using intravenous glucagon. Radiology. 1977;125:25-8. 14. Trenkner SW, Maglinte D, Lehman GA, Chernish SM, Miller RE, Johnson CW. Esophageal food impaction treatment with glucagon. Radiology. 1983;149:40. 15. Schunk JE, Harrison AM, Corneli HM, Nixon GW. Fluoroscopic Foley catheter removal of esophageal foreign bodies in children: experience in 415 episodes. Pediatrics. 1994;94:709-14. 16. Gaigel DO, Fennerty MB. Miscellaneous disease of the esophagus. In: Gaigel DO, Fennerty MB, eds. Textbook of Gastroenterology. 1st ed. Philadelphia: Lippincott Williams and Wilkins; 1999: 1304-1325. 17. Cheng W, Tam PKH. Foreign body ingestion in children: Experience with 1265 cases. J Paediatr Surg. 1999;34:1472-6. 18. Schunk JE. Foreign body ingestion/aspiration. In: Schunk JE, eds. Textbook of Pediatric Medicine. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2006: 307-314.

To compare complication rates and outcomes after removal of oesophageal foreign bodies by endoscopy or by oesophagotomy. Retrospective evaluation of medical records of dogs with oesophageal foreign bodies treated by endoscopy and/or oesophagotomy. Postoperative clinical signs, management, length of hospitalisation, type and rate of complications, and time interval to return to eating conventional diet were compared. Thirty-nine dogs diagnosed with oesophageal foreign bodies between 1999 and 2011 were included in the study. Most common breeds included West Highland white terrier, Jack Russell terrier and shih-tzu. Successful endoscopic removal was possible in 24 out of 32 cases (Group 1), while surgical removal was successful in 15 out of 15 cases (7 of which had unsuccessful attempts at endoscopic removal) (Group 2). Length of hospitalisation, time to removal of gastrostomy tube and time to eat conventional diet did not differ between the groups. After foreign body removal, the incidence of oesophagitis, oesophageal stricture and perforation observed during repeated endoscopy were similar between the groups. In this retrospective study, removal of oesophageal foreign bodies either by oesophagoscopy or oesophagotomy had a similar outcome.