Esophageal Foreign Body Extraction Research Articles

Management of deep neck infections from cervical esophageal perforation caused by foreign body: A case series study

PurposeEsophageal perforation caused by foreign body is common in Chinese medical institutions, and resultant deep neck infections (DNI) is quite different from typical DNI. The purpose of this article was to share our experience on management of this particular type of DNI. Material and methodsA retrospective review was conducted on a consecutive sample of such patients at Capital Medical University Beijing Friendship Hospital from 2015 to 2019. ResultsIn total, 24 cases were recorded. CT scan of the neck and upper thorax was the most useful tool for early diagnosis. Gas formation was not predictive of a worse clinical course. Eleven patients with minor DNI were treated with antibiotics and foreign body removal; while 13 patients with major DNI were treated with neck incision and drainage, ICU observation, and prolonged usage of antibiotics. Outcome was generally good, but major complications, including sepsis and lingual artery rupture, could occur. ConclusionsConservative management, focusing on prompt extraction of esophageal foreign body and adequate antibiotic coverage, can lead to good outcome for mild cases; while in addition to these measures, neck incision, cervical and superior mediastinal exploration, and high negative pressure drainage, should be performed for severe cases.

Innovation in Esophageal Foreign Body Extraction by Gastrointestinal Endoscopy

Innovation in Esophageal Foreign Body Extraction by Gastrointestinal Endoscopy

Extraction of esophageal foreign body with burrowing technique

Extraction of esophageal foreign body with burrowing technique

Extraction of esophageal foreign bodies in children: rigid versus flexible endoscopy

Foreign body (FB) ingestion is a common and potentially serious problem in children. Both rigid (RE) and flexible (FE) endoscopic techniques are used for removal of esophageal FBs; however, there is no consensus amongst pediatric surgeons regarding the best method. This study reviewed our experience managing esophageal FBs using both techniques. A 12-year retrospective review of children admitted with an esophageal FB between 1999 and 2012 was undertaken. Clinical data, management techniques, and complications were abstracted. Differences between these two groups were compared with standard statistical methods. 657 children were treated for esophageal FB ingestion, of which 366 (56%) were treated with FE. The most frequently ingested item was a coin (84%), and FBs were most commonly lodged in the upper third of the esophagus (78%). There was a slightly younger population in the FE group (4.0 vs. 3.3 years, p < 0.01), but otherwise no significant differences were found between the groups. The FB was successfully removed with the initially chosen technique in 97% of patients. Esophageal FBs may be successfully removed with either RE or FE. Since treatment failures were managed with conversion to the other technique, both procedures should be included in the training curriculum.

Therapeutic effect of esophageal foreign body extraction management: flexible versus rigid endoscopy in 216 adults of Beijing.

BackgroundThe aim of this study was to assess the effectiveness and complications of rigid endoscopy (RE) and flexible endoscopy (FE) for the extraction of esophageal foreign bodies (FB) in adults.Material/MethodsA retrospective analysis was conducted on the medical records of 216 adult patients with esophageal FB impaction treated at Peking University Third Hospital, Beijing, China, between January 2008 and December 2012.ResultsThe success rate of FB extraction was 100% (142/142) in patients treated with RE compared to 97.3% (72/74) in those treated with FE (P=0.045). The total incidence of complications in RE-treated patients was lower than that in FE-treated patients (28.2% vs. 45.9%, P=0.009), but the perforation rate was higher (5.6% vs. 1.4%, P=0.135). The incidences of total complications and perforation were associated with the duration of FB impaction in patients who underwent RE (both P<0.05) but not in patients who underwent FE. RE was more frequently used in extraction of FBs located in the upper esophagus (88.7%, 126/142) compared to FE (60.8%, 45/74) (P<0.05). The size of extracted FB was significantly larger in patients treated with FE compared to those treated with RE (P<0.05).ConclusionsBoth RE and FE were effective in the extraction of esophageal FB. However, the perforation rate and the need for general anesthesia were higher in RE-associated extraction. FE may be the preferred endoscopic treatment for the extraction of esophageal FB, except possibly for those impacted in the upper esophagus. FB extraction may produce better outcomes if endoscopy is employed early.

Predictive factors for successful balloon catheter extraction of esophageal foreign bodies

Foreign bodies in the esophagus are common in children. Time from ingestion to presentation is variable, and may not be known. Our center usually performs Foley catheter balloon extraction under fluoroscopy as the first step to attempt removal to prevent all patients from going to the operating room. The efficacy of this procedure has been reported. However, information is lacking about the relationship between presentation variables and the likelihood of success. After IRB approval, we performed a retrospective single-center review from January 1988 to August 2011 of children with an esophageal foreign body. Pearson's correlation was used to evaluate the relationship between variables and successful balloon extraction for P<0.05. A logistic regression was done to evaluate for independence. 819 patients presented with esophageal foreign bodies, with a mean age of 3.3years. 572 patients underwent balloon extraction, 83% successful. Mean ingestion duration was 16.6h with fluoroscopy time of 2.3min and mean number of attempts was 1.5. Successful balloon extraction had a negative correlation with refusal to eat, respiratory distress, cough, wheeze, upper respiratory infection symptoms, stridor, fever, duration of ingestion >1day, unwitnessed ingestion, fluoroscopy time and number of balloon catheter attempts. There was a positive correlation between success and both age and duration of ingestion <1day. Independent predictive factors were number of balloon catheter attempts. Patients with longer duration of ingestion, symptoms from the foreign body and increased number of removal attempts have a decreased likelihood of success with balloon catheter extraction and should not undergo prolonged efforts of removal.

Predictive Factors for Successful Balloon Catheter Extraction of Esophageal Foreign Bodies

Introduction Foreign bodies in the esophagus are common in children. Time from ingestion to presentation is variable, and may not be known. Our center usually performs Foley catheter balloon extraction under fluoroscopy as the first step to attempt removal to prevent all patients from going to the operating room. The efficacy of this procedure has been reported. However, information is lacking about the relationship between presentation variables and the likelihood of success. Methods After IRB approval, we performed a retrospective single-center review from January 1988 to August 2011 of children with an esophageal foreign body. Pearson’s correlation was used to evaluate the relationship between variables and successful balloon extraction for P 0.05. A logistic regression was done to evaluate for independence. Results 819 patients presented with esophageal foreign bodies, with a mean age of 3.3 years. 572 patients underwent balloon extraction, 83 % successful. Mean ingestion duration was 16.6 h with fluoroscopy time of 2.3 min and mean number of attempts was 1.5. Successful balloon extraction had a negative correlation with refusal to eat, respiratory distress, cough, wheeze, upper respiratory infection symptoms, stridor, fever, duration of ingestion [1 day, unwitnessed ingestion, fluoroscopy time and number of balloon catheter attempts. There was a positive correlation between success and both age and duration of ingestion \1 day. Independent predictive factors were number of balloon catheter attempts. Conclusions Patients with longer duration of ingestion, symptoms from the foreign body and increased number of removal attempts have a decreased likelihood of success with balloon catheter extraction and should not undergo prolonged efforts of removal.

Esophageal foreign body extraction in children: flexible versus rigid endoscopy

Esophageal foreign body (FB) impaction is a common emergency in children. The goal of this study was to compare rigid versus flexible endoscopy in esophageal FB extraction in children. In a retrospective cohort study with consecutive data, children with esophageal FB impaction who were admitted between January 2005 and December 2008 to the Stollery Children's Hospital, Edmonton, Canada, were included. Nature of the procedure for FB removal (flexible vs. rigid endoscopy), duration of the procedure, complications, and associated pathology were documented. A total of 140 children were included (81 boys; mean age, 59.8 ± 48.6 (range, 4-203) months). More than half (54%) of patients were aged 3 years or younger. Coins were the most common foreign body (77.9%). Flexible endoscopy was used in 89 patients, rigid in 49, and both in 2 patients. The mean duration of the endoscopic procedure was 10.50 ± 12.2 minutes for FE (95% confidence interval (CI), 7.94-13.08) and 16.49 ± 21.1 minutes for RE (95% CI, 13.75-22.45; p = 0.04). Biopsies were taken in 19% of patients undergoing FE and in 6% of RE (p = 0.04). Both rigid and flexible endoscopy techniques appear to be equally safe and effective in esophageal foreign body extraction. However, performing flexible endoscopy for esophageal foreign body takes a substantial shorter duration compared with rigid endoscopy. Flexible endoscopy would probably allow a better and more thorough examination and, hence, biopsying esophageal mucosa compared with rigid endoscopy.

Solution to the dilemma of retrieving an endoscope from the esophagus

Esophageal impaction usually is caused by ingestion of foreign bodies or a food bolus. 1 Berggreen PJ Harrison ME Sanowski RA Ingebo K Noland B Zierer S Techniques and complications of esophageal foreign body extraction in children and adults. Gastrointest Endosc. 1993; 39: 626-630 Abstract Full Text PDF PubMed Scopus (114) Google Scholar A flexible fiberoptic endoscope is one of the most efficient instruments for investigation in such clinical situations. However, the endoscope itself may cause problems when it becomes difficult to retrieve from the esophagus. Although endoscope-related complications are diverse, we were not able to find a case report on complications related to difficult retrieval of a diagnostic endoscope from the esophagus. 2 Eimiller A Complication in endoscopy. Endoscopy. 1992; 24: 176-184 Crossref PubMed Scopus (29) Google Scholar , 3 Chan MF Complications of upper gastrointestinal endoscopy. Gastrointest Endosc Clin N Am. 1996; 6: 287-303 PubMed Google Scholar , 4 Schauer PR Schwesinger WH Page CP Stewart RM Levine BA Sirinek KR Complications of surgical endoscopy: a decade of experience from a surgical residency training program. Surg Endosc. 1997; 11: 8-11 Crossref PubMed Scopus (24) Google Scholar We present such a case from our clinical experience and discuss a possible solution.

Balloon extraction of esophageal foreign bodies in children

Background: Whereas esophageal foreign bodies are commonly removed with rigid esophagoscopy under general anesthesia, selected foreign bodies also can be removed using a Foley catheter balloon under fluoroscopic control without anesthesia. The authors prefer to initially attempt removal of smooth, radiopaque esophageal foreign bodies using the balloon technique and then proceed to rigid esophagoscopy if unsuccessful. Methods: The authors reviewed their 7-year experience with this approach in 276 children with esophageal foreign bodies. Results: One hundred seventy-three children underwent attempted balloon extraction, and 146 of these underwent successful removal with this method. Fifteen remained lodged in the esophagus and were subsequently removed by esophagoscopy, and 12 passed into the stomach and were observed. The only complication was one episode of epistaxis that resolved. Success of the balloon method was not related to patient age, foreign body duration, location, or presenting symptoms. The use of more than 5 minutes of fluoroscopy time was associated with a low likelihood of successful extraction. Conclusion: The balloon extraction technique is a safe and effective alternative to rigid esophagoscopy for the removal of slected esophageal foreign bodies in children.

Esophageal foreign bodies in children: diagnosis, treatment, and complications.

We performed this study to identify the role of radiology in the diagnosis, treatment, and complications of esophageal foreign bodies in children. We retrospectively reviewed the charts and radiographs of 123 esophageal foreign bodies seen in 118 children at the Medical University of South Carolina from May 1980 through May 1995. Most foreign bodies were coins in the upper esophagus (69%) in infants less than 2 years old (65%) for fewer than 24 hr (60%). The presenting symptoms varied, with 20% of patients asymptomatic. Respiratory symptoms that mimicked upper respiratory tract infections or croup proved misleading with long-standing foreign body retention. Preexisting esophageal disease was present in 17% of patients. The Foley catheter method of foreign body extraction was attempted in 53 cases (43%) and was successful without complications in 46 (87%). Esophagoscopy was attempted in 72 cases (58%) and was successful without complications in 66 (92%). Three patients had major complications: a fatal aorticoesophageal fistula, an extraluminal migration of a coin, and a large esophageal diverticulum. Significant mucosal erosions were shown in six patients on radiologic studies after extraction. Early recognition and treatment of esophageal foreign bodies is imperative because the complications are serious and can be life-threatening. Radiology plays an important role in the initial diagnosis, in recognition of complications, and in treatment. The Foley catheter method of foreign body extraction can be used on some patients, but esophagoscopy remains the safest method of esophageal foreign body extraction.

Fluoroscopic extraction of esophageal foreign body

Fluoroscopic extraction of esophageal foreign body

Techniques and complications of esophageal foreign body extraction in children and adults

To assess the success rates and complications of esophageal foreign body extraction in adult and pediatric patients, the charts of 76 adults and 116 children with endoscopically or radiographically documented esophageal foreign body impaction were retrospectively reviewed. Success rates for rigid esophagoscopy (100%) and flexible endoscopy (96.2%) were not significantly different (p > 0.05). Overall, rigid esophagoscopy had a higher complication rate than flexible endoscopy (10% versus 5.1%, p > 0.05), but this trend did not reach statistical significance. The Foley catheter technique was used predominantly in children with proximally located blunt objects. Our study shows that flexible and rigid esophagoscopy are both safe and effective methods of removing esophageal foreign bodies, but rigid esophagoscopy carries a higher complication rate and therefore should be reserved for patients in whom flexible endoscopy is unsuccessful. The Foley catheter technique is suited only for proximally located blunt objects, and its routine use is not recommended.

Potential hazards of esophageal foreign body extraction

Potential hazards of esophageal foreign body extraction

On the manucript entitled: Potential hazards of esophageal foreign body extraction by C.M.Myer III

On the manucript entitled: Potential hazards of esophageal foreign body extraction by C.M.Myer III

Esophageal edema as a predictor of unsuccessful balloon extraction of esophageal foreign body

Esophageal edema as a predictor of unsuccessful balloon extraction of esophageal foreign body

Extraction of esophageal foreign bodies using biliary stone basket

Extraction of esophageal foreign bodies using biliary stone basket

Basket extraction of esophageal foreign bodies: H.A. Shaffer, B.A. Alford, E.E. Delange, et al. Am J Roentgenol 147:1010–1013, (November), 1986

Basket extraction of esophageal foreign bodies: H.A. Shaffer, B.A. Alford, E.E. Delange, et al. Am J Roentgenol 147:1010–1013, (November), 1986

Esophageal foreign body extraction by biliary stone basket: a case report

Esophageal foreign body extraction by biliary stone basket: a case report

Basket extraction of esophageal foreign bodies.

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.