A Carollo, A Kimyaghalam, A Garrett, J Thoens, D.j. Smith. Northside Medical Center
The most common esophageal foreign body (FB) in adults in the Western world is impacted meat or other food. More than 80% of ingested FB pass without need for intervention. The mainstay of retrieval is via an endoscopic approach. Removal may be in a piecemeal or en-bloc fashion with the use of a variety of endoscopic tools including polypectomy snare, retrieval net, friction-fit adaptor or banding cap. If unable to retrieve the FB, it is recommended that the food bolus not be advanced to the stomach until after the distal portion of the esophagus is inspected, as the push technique may lead to perforation. During the use of the push technique a bolus of glucagon may be administered to allow relaxation of the lower esophageal sphincter (LES). The retrieval of impacted food bolus can be tedious and time consuming. We present a case in which a novel approach to the retrieval of food bolus was used in conjunction with the use of standard retrieval techniques.
A 62 year old female presented with complaints of epigastric pain, dysphagia, vomiting, weight loss and constant sensation of fullness. During work-up a chest x-ray showed air-fluid level of the esophagus suggestive of obstruction and she was taken for urgent esophagogastroduodenoscopy (EGD). The patient was intubated for airway protection. The endoscope was advanced and large amount of food bolus was encountered at 32cm into the esophagus. Multiple attempts were made to retrieve the FB with the use of retrieval net and forceps, due to the degree of stenosis of the oropharynx an overtube was not utilized. The FB was being retrieved piece meal and was becoming difficult to remove due to adherence to the esophageal wall. Decision was made to advance the endoscope past the FB to examine the distal esophagus and stomach, which appeared to be in good shape, we then proceeded to administer glucagon and push technique, which were unsuccessful. The decision was made to proceed with continuous irrigation via the endoscope and suctioning via an Ewald orogastric tube. We began to administer multiple liters of sterile water irrigation with simultaneous suction on a 34 french Ewald tube. The Ewald tube tip always remained in view of the endoscope and food particles were continuously irrigated into the tube and removed via manual intermittent suction. In conjunction with standard techniques this approach made it possible to remove the entire FB in a timely manner.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80696
Program Number: P341
Presentation Session: Poster (Non CME)
Presentation Type: Poster
