Esophageal Foreign Body Removal

Esophageal foreign body endoscopy

Esophageal foreign body endoscopy is a lower procedure in the endoscope that is minimally invasive and serves to locate and remove objects lodged in the esophagus (food pipe). It is among the most effective and regularly applied treatment in both children and adults particularly where the object is unable to pass on its own.

What is a foreign body in the esophagus?

Any object that becomes lodged in the esophagus instead of going down into the stomach is considered a foreign body. Some common examples are: 

• Children: coinage, button batteries, toy parts, magnets.
• Adults: food bolus (meat), bone of fish/chicken, dentures, pills.
• Items with high risk: button batteries, sharp objects, multitude of magnets.

They can cause pain, obstruction, and even life-threatening problems if not removed promptly. 

Why Endoscopy Is Needed

Endoscopy should be performed in case of:

• The object is not in motion and is stuck.
• The patient is having problems with swallowing, dropping saliva, chest pain or vomiting.
• The object is sharp, corrosive or a battery.
• The symptoms last longer than 24 hours.

Types of Endoscopy Used

Flexible Endoscopy

• Most commonly used
• Done under sedation
• Food bolus, coins, small objects.

Rigid Endoscopy

• Often used in children
• Performed in general anaesthesia.
• Ideal in the large or sharp objects of upper esophagus.

Foreign body esophagus removal

The cutting of the foreign body in the esophagus is done with an endoscope, a flexible (or sometimes rigid) tube with a camera and instruments. 

Procedure 

Preparation

• Patient fasting for 6–8 hours.
• IV and monitoring (pulse, oxygen, BP).
• Sedation/ anaesthesia on demand.

Endoscope Insertion

• The endoscope is inserted during the mouth and then through the esophagus.
• The object is visualized.

Object Removal

Depending on the object special tools are applied:

• Claw/coin grabbers, bone grabbers.
• Units of odd articles.
• Hoards against big or sharp things.
• Mucosal damage is sometimes prevented by using a protective hood.

Post-Removal Assessment

• Examine the mucosal injury, bleeding, or perforation.
• In case of suspected injury X-ray or contrast study is occasionally performed.

Recovery

• Mostly short; the majority of patients discharge home.
• Soft diet for 24 hours.

Pediatric esophageal foreign body

A foreign body that is lodged in the esophagus of a child mostly as a result of accidental ingestion. Small anatomy and exploratory behavior are risk factors among pediatric patients.

Routine CFBs in Children:

• Coins (most common)
• Small toys, buttons
• Button batteries (emergency)
• Magnets (a series of magnets are hazardous)
• Bones or food bolus

Clinical Presentation

Children may present with:

• Difficulty in swallowing or eating.
• Too much saliva
• Vomiting 
• Chest pain or discomfort
• Coughing, wheezing or breathing difficulties when object compresses air way.
• This is sometimes asymptomatic, particularly with small coins.

Red flags that needed to be taken as urgent:

• Button battery ingestion (may lead to tissue necrosis in 2 hours)
• Several magnets (perforation threat and fistulae)
• Signs of airway obstruction

Esophageal foreign body complications

The complications are dependent on the type of object, time of duration of impaction, and the age of the patient. The occurrence of some complications is life threatening when they are not properly managed.

• Mucosal Injury
• Esophageal Perforation
• Bleeding
• Stricture Formation
• Fistula Formation
• Infection
• Airway Compromise

Esophageal foreign body recovery

Recovery is related to the type of object, time of impact, the way of extraction, and the existence of complications. The majority of the cases (uncomplicated ones) are self-limiting and the complicated ones (perforation, battery ingestion) may require the monitoring.

Post-Procedure Care: Acute

• Observation: Patients are monitored in recovery until the effects of sedation/anaesthesia wear off.
• Vital Signs Monitoring: The heart rate, oxygen saturation, and respiratory rate are monitored.
• Experiencing Pain: The sore throat is not very severe; the patient can be given analgesics.
• Airway Check: This is especially if the object is large or sharp (particularly in children).

Food & Fluid Intake

Initial Diet:

• Explicit juices during the initial few hours.
• Gradual change to soft diet (soups, mashed food) accordingly.
• Avoid: Hard, sharp, or sticky foods that are more likely to damage the mucosal lining should be avoided as well during the first couple of days because of the risk of mucosal damage.

Medications

• Acid suppression: Proton pump inhibitors (PPI) used if mucosal irritation/ulceration occurred.
• Antibiotics: Just if there was a perforation, gross mucosal damage, or infection. 
• Narcotics: To use in mild throat pain.

Follow-Up

• Once esophagus is mending, usually in 1-2 weeks.

Repetition of imaging or endoscopy could be done in case there was:

• Esophageal perforation
• Button battery ingestion
• Multiple magnet ingestion
• Long-impacted children may require esophagus dilatement in later life in case there is stricture.

Recovery Time

• Simple cases: 24 to 48 hours; most patients are allowed to return to normal diet within 1 to 2 days.
• Complex cases: It might be a few days in the hospital, especially if there's been a perforation, infection, or if a battery was swallowed. 

Best hospital for esophageal foreign body removal India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Foreign bodies of the esophagus are typical emergencies particularly in children and may be benign like coins or dangerous like button batteries and several magnets. Timely diagnosis and immediate therapy is essential in order to avoid severe complications, such as perforation, bleeding, infection, airway block, and strictures. The gold standard is endoscopic removal -flexible or rigid, which has a high success and is least invasive. The short-term follow-up, dietary changes and post-procedure follow-up are the measures of post-procedure care required to ensure full recovery and avoid late complications. Through early intervention, majority of patients get back on their feet and start swallowing normally. Education and close monitoring of children have continued to play a major role in preventing occurrences.

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FAQ

1. Who is at risk?

• Children (particularly, 6 months to 5 years) owing to exploration behavior
• Older people using dentures
• Patients with dysphagia (such as those with esophageal strictures, neurological disease) 

2. When is it an emergency? 

As soon as possible medical care is required to:

• Button battery ingestion (may result in tissue injury in 2 hours)
• Several magnets (may result in pressure necrosis and fistulas)
• Sharp objects
• Airway compromise, bleeding, perforations

3. How is it diagnosed?

• History of ingestion
• Physical examination
• Imaging: X-ray (the majority of objects), CT scan or contrast study in the event of radiolucency.
• Endoscopy is diagnostic and curative.

4. How is it removed?

• Flexible endoscopy: This is the method of choice to most objects; objects can be seen and removed using tools.
• Rigid endoscopy: It is applied to large, sharp, or proximally-lodged objects particularly in children.
• Surgical treatment: Uncommon, exceptionally when endoscopic deletion does not help or the outcome of complications develops.

5. Can it be prevented?

• Place small objects, coins, batteries, and magnets with the reach of children.
• Supervise the children whilst eating.
• Educate caregivers on the significance of early recognition of swallowing disorder. 
• Avoid tries to take away objects or make ones vomit.