USE OF SAEED BANDING DEVICE FOR REMOVAL OF IMPACTED FOOD IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS

Abstract

Introduction: Esophageal food impaction in children is rare and can result from an anatomical narrowing, non-specific motility disorder or eosinophilic esophagitis. Patients with retrosternal pain and difficulty swallowing due to the impaction require endoscopic retrieval. Snares and nets have been used, but the impacted food is usually fragile and multiple attempts are generally necessary. We report four patients with esophageal food impaction that was safely removed using the Saeed banding device. Methods and Results: Four patients, median age 12 years, all male, presented with retrosternal pain and drooling after a meal. Three patients had eosinophilic esophagitis (EE) and one had no specific abnormality. Upper endoscopy under anesthesia confirmed the site of food impaction in the mid and lower esophagus in all four, and distance to the impaction was measured from the lips. The endoscope was removed and a housing cylinder from a Saeed bander without the bands (device used for esophageal variceal ligation), was snuggly fixed to the tip of the endoscope (Pentax EG-2730). The endoscope, with the housing cylinder in place, was then reintroduced into the esophagus, the plastic cylinder was placed on the food and suction applied. After the food was drawn into the cylinder, the scope was removed slowly, with continued suction until the endoscope was out of the mouth. In all four patients, the impacted food (a piece of chicken in two, and a piece of hot dog in two) was removed in a single attempt. Conclusions: Food impaction is being increasingly recognized in children with EE, and this technique offers an easy and safe method to remove impacted food from the esophagus.