Endoscopic foreign body retrieval

Endoscopic foreign body retrieval refers to the removal of ingested objects from the esophagus, stomach and duodenum by endoscopic techniques. It does not involve surgery, but rather encompasses a variety of techniques employed through the gastroscope for grasping foreign bodies, manipulating them, and removing them while protecting the esophagus and trachea. It is of particular importance with children, people with mental illness, and prison inmates as these groups have a high rate of foreign body ingestion. Commonly swallowed objects include coins, buttons, batteries, and small bones (such as fish bones), spoons, and toothbrushes

There are several situations in which endoscopic techniques are not indicated, such as for small blunt objects less than 2.5 cm which have already passed into the stomach (as these usually do not obstruct anywhere else), when there is perforation of the esophagus or mediastinitis (inflammation of structures around the esophagus), and for narcotic containing bags or condoms that have been ingested, because of the risk of overdose if they are ruptured.

Prior to undertaking endoscopy, attempts should be made to locate the foreign body with x rays or other non invasive techniques. Alternative approaches, including the use of metal detectors, have also been described. X rays are also useful for identifying the type of foreign body ingested and complications of foreign body ingestion, including mediastinitis and perforation of the esophagus. Once the foreign body has been identified with the gastroscope, various devices can be passed through the gastroscope to grasp or manipulate the foreign body. Devices used include forceps, which come in varying shapes, sizes and grips, snares, and oval loops that can be retracted from outside the gastroscope to lasso objects, as well as Roth baskets (mesh nets that can be closed to trap small objects), and magnets placed at the end of the scope or at the end of orogastric tubes. Some techniques have been described that use foley catheters to trap objects, or use two snares to orient foreign bodies.