Foreign Body Removal

Foreign body and food bolus impaction is one of the most common emergent endoscopy indications. Adult food impactions are most often meat boluses lodged at a strictured esophagus — eosinophilic esophagitis, peptic strictures, Schatzki rings, and post-fundoplication anatomy are the typical underlying causes. Pediatric and psychiatric ingestions are more diverse: coins, batteries, sharps, magnets, and packets of illicit drugs.

Timing is determined by symptoms and ingestion type. Sharp objects, button batteries (esophageal), and disk magnets require urgent (within 2–6 hours) endoscopy because of perforation, fistula, and pressure-necrosis risk. Food impactions causing complete esophageal obstruction (the patient cannot handle secretions) need urgent intervention. Smooth objects in the stomach and proximal duodenum that have not advanced after 24–48 hours can be retrieved electively.

Technique varies by object. Distal transparent caps and mega-caps allow controlled scope-tip extraction of food boluses and round objects. Tripod and rat-tooth graspers, retrieval nets, polypectomy snares, and overtubes (to protect the airway and esophagus during extraction of sharps) are workhorses of the foreign-body cart. Push-through into the stomach is acceptable for boluses without an underlying tight stricture; otherwise piecemeal retrieval is preferred. Always inspect the underlying mucosa after extraction — the strictured anatomy is the real diagnosis.