Endoscopic removal of sharp foreign bodies impacted in the esophagus

Background and study aims: Impacted sharp foreign bodies in the esophagus can be very difficult to manage. When attempts are made to remove such objects inappropriately, life-threatening complications such as perforation can occur. The aim of this study was to evaluate the safety and efficacy of endoscopic removal of impacted sharp foreign bodies in the esophagus using proximal dilatation with an oral side balloon or transparent cap. Patients and methods: A total of 22 patients (10 men, 12 women) with impacted sharp foreign bodies in the esophagus underwent endoscopic extraction. The following technique was successfully performed at our hospital. An oral side balloon (Top Co., Japan) for esophageal variceal sclerotherapy was attached to the distal part of the endoscope. With the patient under local anesthesia, the endoscope was inserted as far as the proximal part of the esophageal foreign body. The oral side balloon was then gradually inflated. Dilatation of the proximal part of the esophagus made it possible to release the impacted sharp foreign body from the esophageal wall. A transparent cap was used for foreign bodies in the upper esophagus when there were difficulties with the oral side balloon. Results: The types of foreign body removed were fish bones (n = 9), press-through packages (n = 8), chicken bones (n = 3), dentures (n = 1), and a wrist watch (n = 1). Endoscopic removal was successful in all but one of the cases, in which a fish bone had to be extracted surgically. Conclusions: The proximal dilatation method using an oral side balloon or transparent cap is safe and effective in removing sharp foreign bodies from the esophagus, avoiding surgery and possible perforation.