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Case Reports
. 2021 Sep 7;2(1):e41.
doi: 10.1002/deo2.41. eCollection 2022 Apr.

Successful removal of an accidentally swallowed press-through package sheet using a detachable snare: A case report

Fumihiro Mawatari  1 , Naohiro Komatsu  2 , Ryosaku Oshiro  3 , Tetsuhiko Arima  1 , Sachiko Fukuda  1 , Yoshiko Kita  1 , Aiko Fukahori  1 , Kazuhiko Nakao  2
Affiliations
Case Reports

Successful removal of an accidentally swallowed press-through package sheet using a detachable snare: A case report

Fumihiro Mawatari et al. DEN Open. .

Abstract

Accidental swallowing of press-through package (PTP) sheets that could cause esophageal perforation is commonly encountered in emergency departments requiring early detection and removal. We report a case in which an accidentally swallowed PTP sheet was removed from the esophagus using a detachable snare after usual endoscopic methods proved ineffective. A Japanese woman in her 60s visited the emergency department with a persistent sore throat. Cervicothoracic computed tomography revealed presence of a PTP sheet in the cervical esophagus, and emergency endoscopy was performed. Pre-endoscopy simulations using a sheet identical to the one swallowed by the patient indicated that the sheet would not have been retrievable using an overtube (its inner diameter was smaller than the sheet's diameter) and grasping forceps (they slipped off the sheet). It was successfully removed using a detachable snare, a device normally employed in colorectal polypectomy, allowing us to ligate the end of the sheet and pull it into the overtube. To the best of our knowledge, this is the first report of endoscopic removal of a PTP sheet from the esophagus using a detachable snare. We suggest that this novel method would facilitate removal of esophageal PTP sheets.

Keywords: detachable snare; endoscopic removal; foreign body; grasping forceps; press‐through package sheet.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Cervicothoracic computed tomography reveals a 17 mm2 PTP sheet inside the cervical esophagus
Figure 2
Figure 2
Simulations before endoscopy. (a) The diameter of the press‐through package sheet is larger than the inner diameter of the overtube. (b) Attempting to pull the sheet into the overtube after grabbing it diagonally with forceps is not successful. (c) The detachable snare used for endoscopy in this study. (d) Esophagoscopy showing a press‐through package sheet (17 × 17 mm) in the upper esophagus
Figure 3
Figure 3
Procedure for removal of the press‐through package (PTP) sheet from the esophagus using an indwelling snare. (a and b) The detachable snare is opened, with the opening parallel to the esophagus, and the left side of the PTP sheet is ligated. (c) The ligated side of the PTP sheet is grasped with grasping forceps. (d) The sheet was pulled into the overtube for removal
Figure 4
Figure 4
Removal of a different type of press‐through package (PTP) sheet and use of a different ligation site. (a and b) A detachable snare is used to remove a hard, large PTP sheet with a large tablet. (c and d) By changing the ligation site, all edges of the sheet can be folded inward, and it might be possible to remove the PTP sheet without the use of an overtube or large diameter tip hood
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