Western view of the management of gastroesophageal foreign bodies

Abstract

The best modality for foreign body removal has been the subject of much controversy over the years. We have read with great interest the recent article by Souza Aguiar Municipal Hospital, Rio de Janeiro, Brazil, describing their experience with the management of esophageal foreign bodies in children. Non-endoscopic methods of removing foreign bodies (such as a Foley catheter guided or not by fluoroscopy) have been successfully used at this center. These methods could be an attractive option because of the following advantages: Shorter hospitalization time; easy to perform; no need for anesthesia; avoids esophagoscopy; and lower costs. However, the complications of these procedures can be severe and potentially fatal if not performed correctly, such as bronchoaspiration, perforation, and acute airway obstruction. In addition, it has some disadvantages, such as the inability to directly view the esophagus and the inability to always retrieve foreign bodies. Therefore, in Western countries clinical practice usually recommends endoscopic removal of foreign bodies under direct vision and with airway protection whenever possible.

Keywords: Children; Flexible endoscopy; Foley catheter; Foreign bodies.

Figure 1

Short-blunt objects: A ring. The ring in the esophagus was observed for 24 h before endoscopic removal. A: Esophagus; B: Stomach; C: Rat-tooth forceps.

Figure 2

Sharp-pointed objects. A: Fish bone; B: Nail; C: Chicken bone. Removal with alligator forceps.

Figure 3

Food bolus impaction in patient with eosinophilic esophagitis. A: Removal with a snare; B: Esophageal rings, linear furrows and mucosal fragility; C: Stricture.