Clinical Reference Card

Endoscopic Foreign Body Removal

ENDOCOLLAB
Retrieval devices for endoscopic foreign body removal: snares, polyp grasper, Roth net, grasping forceps, tripod, baskets, capuchon, cap, and overtube.
The retrieval device set, from the EndoCollab lecture "Endoscopic Management of Foreign Bodies (part 1)"

The Five-Element Tray

  • 1 · Snare — include a hexagonal snare; the polyp grasper works here too
  • 2 · Overtube — esophageal, gastric, colonic lengths; enteroscopy overtubes reach the small bowel
  • 3 · Cap / capuchon — mucosal shield; can be improvised from a plain glove
  • 4 · Net — Roth or octopus type; hexagonal frames keep opening memory
  • 5 · Toothed forceps — rat-tooth, alligator, or raptor; add a mini rat-tooth
Basket caveat: many baskets are ERCP designs with 2.9–3.0 mm sheaths — they will not pass a 2.8 mm gastroscope channel. Check before stocking.

Sharp-Object Extraction Protocol

  1. Plan before you pull. Align the object's axis with the axis of the GI lumen.
  2. Clear the field. Suction bile and fluid before grasping.
  3. Disembed, don't yank. Grasp firmly; free the stuck end with gentle torquing movements.
  4. Control the sharp end. Let the sharp tip trail during withdrawal; protect the wall with an overtube or cap.
  5. Insufflate to dilate. Air or CO₂ widens the lumen away from the sharp tip; desufflate at the end.
  6. Bend what will not fit. A long object that cannot enter the overtube can be bent so the sharp end points away from the mucosa.
  7. Re-inspect and finish. Look at the impaction site afterward; a clip can be placed at the site.

Clinical Pearls

Timing. Sharp/pointed objects: emergency. Magnets: urgent (6–12 h — they corrode principally the stomach and esophagus). Selected coins and other objects: non-urgent.
Imaging. AP + lateral X-ray road-maps metal, coins, batteries. CT is sometimes the safest approach for sharp objects and impactions near vessels. No barium — aspiration risk.
Vessels. Sharp object near the aorta: image first, involve surgery — do not pull blind.
Overtube bonus. Repeated passes become safe; food-bolus debris can be cleared over many back-and-forth endoscopies.
Team. Removal is not always endoscopically feasible — keep surgery available.