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Endoscopic foreign body retrieval

2007 Schools Wikipedia Selection. Related subjects: Health and medicine

   Endoscopic still of gastric foreign body (toothbrush)
   Enlarge
   Endoscopic still of gastric foreign body (toothbrush)

   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), but can include more complex objects, such
   as eyeglasses, spoons, and toothbrushes (see image).

Indications and contraindications

   Some patients at risk for foreign body ingestion may not be able to
   give an accurate medical history of ingestion, either due to age or
   mental illness. It is important that physicians treating these patients
   recognize the symptoms of esophageal foreign body impaction requiring
   urgent intervention. Most frequently, these include drooling and the
   inability to swallow saliva, neck tenderness, regurgitation of food,
   stridor and shortness of breath if there is compression of the trachea.

   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.

   Foreign bodies should be removed from the esophagus within 24 hours of
   ingestion because of a high risk of complication.

Non-invasive testing

   Chest X-ray showing a Canadian dollar coin in the esophagus of a young
   child
   Enlarge
   Chest X-ray showing a Canadian dollar coin in the esophagus of a young
   child

   Prior to undertaking endoscopy, attempts should be made to locate the
   foreign body with x-rays or other non-invasive techniques. For
   radio-opaque objects, x-rays of the neck, chest and abdomen can be used
   to locate the foreign body and assist endoscopy. 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.

Endoscopy

   Endoscopic retrieval involves the use of a gastroscope or an optic
   fibre charge-coupled device camera. This instrument is shaped as a long
   tube, which is inserted through the mouth into the esophagus and
   stomach to identify the foreign body or bodies. This procedure is
   typically performed under conscious sedation. Many techniques have been
   described to remove foreign bodies from the stomach and esophagus.
   Usually the esophagus is protected with an overtube (a plastic tube of
   varying length), through which the gastroscope and retrieved objects
   are passed.

   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.

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   with only minor checks and changes (see www.wikipedia.org for details
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