Rigid Esophagoscopy for Foreign Body Extraction: Results and Complications in the Endoscopic Era.

Introduction Rigid esophagoscopy (RE) has long been a part of otolaryngology practice. In the past decades, the procedure was less commonly performed due to the advances and availability of flexible endoscopic techniques. This study aims to describe the outcomes of RE performed to treat foreign body ingestion and to evaluate risk factors associated with postoperative complications. Methods Patients who underwent RE to treat foreign body ingestion in an otolaryngology emergency department of a Portuguese tertiary university hospital, between 2010 and 2020, were included. A total of 162 cases were analyzed, and data was collected retrospectively. Results The most common foreign bodies were meat bone (31.5%, n = 47), food impaction (28.8%, n = 43), and fish bone (19.5%, n = 29). The proximal esophagus was by far the most frequent location (80%, n = 118). Esophageal perforation occurred in 8% (13 patients), and there was a 2.5% (n = 4) mortality rate. The odds ratio of an esophageal perforation if the foreign body was completely or partially located outside the proximal esophagus was 4.67 times that of a foreign body exclusively in the proximal esophagus (OR = 4.67 [95% CI: 1.39-15.72]; p = 0.016; Fisher's exact test). Conclusion RE remains an effective and important technique in the management of ingested foreign bodies, particularly if endoscopic removal is unsuccessful. Foreign body location outside the proximal esophagus was associated with esophageal perforation.

Non-operative management of iatrogenic esophageal perforation in a 6-year-old child.

BACKGROUND: Esophageal perforations are rare, the most common encountered esophageal perforation is iatrogenic in origin. It can be life-threatening if not diagnosed and treated early. Medical treatment has been recommended primarily in hemodynamically stable children. Drainage of intrathoracic or periesophageal fluid formation should be reserved to patients with hemodynamic instability. Surgical intervention may seldomly be required, depending on the localization and size of the defect. CASE REPORT: A 6-year-old male patient was referred to our clinic due to an esophageal perforation whilst removing the foreign body from upper esophagus under direct vision of a rigid esophagoscope. A radiologic appearance similar to esophageal duplication was detected along the esophagus in the esophagogram. A secondary esophagoscopy was carried out by our clinic, laceration at the esophagopharyngeal junction and dissection along the esophagus were observed and the foreign body was propelled into the stomach. The patient, whose clinical condition was stable, was managed medically without the need for a surgical intervention. CONCLUSIONS: Esophageal perforation is rare, yet perilous if not handled properly. We do not encounter this clinical entity frequently. Despite its rarity it can arise either iatrogenically or while managing a previous complication such as a simple nasogastric tube insertion in an infant or during an endoscopy for an esophageal foreign body. Its management is challenging, and we believe that non-operative treatment is still an important option in childhood esophageal perforations.

H-Type Tracheoesophageal Fistula Cannulation for Rapid Intraoperative Localization.

Various techniques for tracheoesophageal fistula cannulation have been reported. In this case, we created a loop using a plastic catheter. The loop allowed us to create traction for rapid intraoperative localization and to pull a difficult-to-reach fistula, superiorly into the neck, to be reached through a cervical approach. Laryngoscope, 133:2425-2427, 2023.

Foreign Body Denture in the Esophagus for 2 months: A Case Report.

Foreign body (FB) denture with 3 teeth impacted in the esophagus for 2 months without any obvious symptoms and signs is being reported. The FB, 4*3 cm was removed 26 cm from the upper incisor with rigid esophagoscope. The post-operative period was uneventful, and follow up endoscopy demonstrated normal findings.

A rare case of food bolus impaction on top of stricture formation secondary to a 12- year retained foreign body (denture) in the esophagus of a 34-year old male: A case report

OBJECTIVES@#This paper aims to present a rare case of a 34-year old male who had esophageal food bolus impaction on top of stricture formation secondary to a retained 12-year esophageal foreign body (denture). It also aims to state the significance of proper and comprehensive history taking, physical examination and corresponding ancillary procedures to arrive at its diagnosis and to highlight the importance of a multidisciplinary team in the prevention and management of complicated foreign body (FB) impaction.@*DESIGN@#Case Report@*SETTING@#Government Tertiary Hospital@*PATIENT@#One@*RESULTS@#A 34-year old male presented with one day history of dysphagia after ingesting a chunk of pork. He had no other symptoms and was not in any respiratory distress. Physical examination was unremarkable except for missing dentition (teeth #8, #9 by universal notation system). Radiographic imaging, esophagogram and contrast-enhanced chest CT scan revealed partial proximal esophageal obstruction probably secondary to retained foreign body at the level ofT5 vertebra. Rigid esophagoscopy with removal of foreign body (food bolus) was done. However, there was difficulty insinuating the scope beyond this level. Further investigation and the use of multispecialty collaboration eventually led to the retrieval of a 12-year denture covered by a bimucosal flap with surrounding stricture formation.@*CONCLUSION@#Foreign body impaction, while more commonly found in the pediatric population, may also occur in adults especially those with edentulism, psychiatric disorders, alcoholism and preexistent esophageal pathologies. In rare cases, patients may be asymptomatic resulting to a delay in its diagnosis. In addition to a well-taken history and physical examination, direct visualization and computed tomography are vital for evaluation. A multidisciplinary approach is critical in its management especially when anticipating difficult extraction and considering FB impaction complications.

[Application of esophageal CT to establish the evaluation model of foreign body position in rigid esophagoscopic surgery].

Objective:Establish a correlation model with the true position of the foreign body in the esophageal foreign body surgery using the relevant diameter of the esophageal foreign body computed tomography（CT）. Methods:Thirty-three patients who were diagnosed with esophageal foreign bodies by esophageal CT in the emergency department of the Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, were selected to measure the CT-related diameters of the esophageal tube（airway length, hyoid anterior edge-mandibular distance, incisor extension line-Posterior nasal ridge, distance from foreign body to hard jaw, distance from foreign body to incisor, front and back nasal crest line-spine line included angle, front and back nasal crest line and airway length line included angle, the lowest point of mandible-highest point of hyoid bone-and Spine angle）, record the height and weight of the patient and calculate the body mass index（BMI）. During the operation, the patient's head is fully tilted back, and the rigid esophagus is inserted through the mouth, and the front end of the esophagus is recorded when it touches a foreign body. The method of multivariate linear analysis was used to calculate the CT diameter that correlated with the distance between the foreign body and the incisor during the operation. Results:The most common foreign body in the esophagus is jujube pit（14 cases）, followed by fish bones（13 cases）; the distance between the foreign body and the hard jaw, the incisor teeth measured by CT of the esophagus is less than the actual distance between the foreign body and the incisor during the operation（P<0.001）, the difference was statistically significant. Multiple linear regression analysis found that the patient's BMI（P=0.037） and the distance of the foreign body from the hard jaw（P<0.001） were correlated with the actual distance of the foreign body from the incisor during the operation. LR=3.708+0.130×BMI+0.857×Lct（cm）, R²=0.736, adjusted R²=0.719. Conclusion:The distance between the foreign body and the hard jaw measured by esophageal CT combined with the patient's BMI can predict the distance of the foreign body during rigid esophagoscopic surgery under general anesthesia and provide a certain reference value for the detection of foreign body during the operation.

Emergency management of jujube pit esophageal impactions using rigid esophagoscopy in the aged.

OBJECTIVE: To study the emergency management of esophageal jujube pit ingestion. STUDY DESIGN: Retrospective case series. METHODS: A retrospective study of 114 consecutive cases of jujube pits esophageal impaction during 3 months was performed. RESULTS: One hundred and fourteen cases were confirmed as jujube pit esophageal impaction using contrast-enhanced radiography. All jujube pits were retrieved using rigid esophagoscopy under general anesthesia as outpatients, except one case where a direct laryngoscope was used. In four cases, esophageal perforation was found, the patients were treated with conservative measures, and none died. CONCLUSION: Jujube pit esophageal impaction is characterized by a high incidence of perforation. The conservative management of cervical perforation is effective in this study. Rigid esophagoscopy under general anesthesia is safe for jujube pit esophageal impaction. LEVEL OF EVIDENCE: 4.

Management of deep neck infections from cervical esophageal perforation caused by foreign body: A case series study.

PURPOSE: Esophageal perforation caused by foreign body is common in Chinese medical institutions, and resultant deep neck infections (DNI) is quite different from typical DNI. The purpose of this article was to share our experience on management of this particular type of DNI. MATERIAL AND METHODS: A retrospective review was conducted on a consecutive sample of such patients at Capital Medical University Beijing Friendship Hospital from 2015 to 2019. RESULTS: In total, 24 cases were recorded. CT scan of the neck and upper thorax was the most useful tool for early diagnosis. Gas formation was not predictive of a worse clinical course. Eleven patients with minor DNI were treated with antibiotics and foreign body removal; while 13 patients with major DNI were treated with neck incision and drainage, ICU observation, and prolonged usage of antibiotics. Outcome was generally good, but major complications, including sepsis and lingual artery rupture, could occur. CONCLUSIONS: Conservative management, focusing on prompt extraction of esophageal foreign body and adequate antibiotic coverage, can lead to good outcome for mild cases; while in addition to these measures, neck incision, cervical and superior mediastinal exploration, and high negative pressure drainage, should be performed for severe cases.

Esophageal Button Battery in the Pediatric Population: Experience from a Tertiary Care Center.

OBJECTIVES: To highlight different patterns of clinical presentation, share authors' experience in the management of children following button battery ingestion and their outcomes. METHODS: This is a single center descriptive cohort study with a total duration of 5 y (January 2014 through December 2018). Battery removal was performed by urgent rigid esophagoscopy following department protocols. Outcomes and complications were observed in the post-operative period in all children. Contrast esophagogram was performed at 4-6 wk post battery removal for assessing esophageal emptying and detecting sequelae (stricture). RESULTS: Fifty-two children (M:F = 31:21) with a mean age (+SD) at presentation of 47 (+27) mo were managed at authors' center during the study period. Most common source of button battery was electronic appliance remote (50%) and common symptoms at presentation were vomiting after feeds, dysphagia, chest pain etc. During endoscopic retrieval, majority (60%) of the batteries were lodged in the upper esophagus and predominant impaction was noticed at anterior wall (81%) of esophagus. Upon injury assessment, grade 3 followed by grade 2 were detected in 59% and 41% cases respectively. Five children developed complications. Two deaths due to catastrophic hemorrhage (aorto-esophageal fistula) and refractory sepsis (tracheoesophageal fistula) occurred in present cohort. While contrast esophagogram was normal in all survivors, self-limiting symptoms like mild chest pain during swallowing and cough were observed during the follow-up. Median (IQR) duration of hospital stay and follow-up were 2 d (1-2.75) and 14.5 mo (8.5-17.5) respectively. CONCLUSIONS: Accidental button battery ingestion can be life-threatening. Diagnosis is often delayed due to non-specific clinical presentation and unwitnessed ingestions. Esophagoscopic retrieval is the treatment modality of choice. Despite having significant esophageal injury at the time of removal, no long-term sequelae (clinical or radiological) were observed in present study.

Clinical Analysis of Denture Impaction in the Esophagus of Adults.

Denture impacted in the esophagus of adults has been a complex foreign body for otolaryngologists. We reviewed clinical characteristics, diagnosis, and treatment of these patients and evaluated computed tomography (CT) scans to identify a better method of dealing with such tricky situations. Twenty-nine patients who underwent rigid esophagoscopy were included in this retrospective study conducted at the University hospital. The patients underwent preoperative tests and examinations, including complete blood count, blood type and coagulation, electrocardiogram, and CT. The commonest symptoms were retrosternal pain, dysphagia, and odynophagia. Duration of the foreign body impacted within 24 h was 65.5%. CT findings revealed that 4 of 24 cases had complications in the upper esophagus, with 3 of the 4 cases in the mid-esophagus and 1 in the lower esophagus. Complications were related to the duration and location of the obstruction (P < 0.05). The location and complications based on CT findings were coherent with rigid esophagoscopy findings. Denture impaction in the esophagus can be fatal. Early intervention is crucial for prognosis. CT is used for diagnosing and guiding doctors in managing. The commonest location of impacted dentures was the upper esophagus with a lower incidence of complications. The incidence of an impacted denture in the mid-esophagus was low but with a high risk of complications. The incidence of an impacted denture in the lower esophagus was rare. Surgery and proper treatment ensure a good prognosis.

A comparison of clinical effects of removing foreign bodies from esophagus by rigid esophagoscope and flexible esophagoscope / 中国胸心血管外科临床杂志

@#Objective    To collect the data of esophageal foreign body patients, and to evaluate the clinical effects of two different surgical methods in our hospital. Methods    The clinical data of 294 patients who were treated in Gansu Provincal Hospital from January 2012 to June 2018 were analyzed retrospectively. The clinical data were collected and analyzed by SPSS 22.0. In order to to evaluate the efficacy of flexible esophagoscope (FE) and rigid esophagoscope (RE) in the treatment of esophageal foreign bodies.The patients were divided into two groups: a RE group including 118 patients with 62 males and 56 females at age of  6 (3-37) years and a FE group including 176 patients with 84 males and 92 females at age of 6 (3-59) years. Results    There was no significant difference in age, age stratification, gender and foreign body type between the two groups. There was a statistical difference in the initial clinical symptoms (P=0.041) or in esophageal foreign bodies position (P=0.037) between the two groups. The success rate of foreign body removal was similar between the two groups (P=0.632). The success rate was 88.9% (105/118) in the RE group, 87.5% (154/176) in the FE group. The operation time was significantly longer in the RE group than that in the FE group (10.8 ±17.4 min vs. 17.5±21.6 min, P<0.001). The postoperative hospitalization time in the RE groups was longer than that in the FE group (21.5 ±24.2 hours vs. 12.5 ±21.3 hours, P<0.05). There was a statistical difference in the incidence of postoperative complications between the two groups (P=0.034). In the RE group, the main complication was mucosal edema (15.3%). And the rate of bleeding was higher (15.9%) in the FE group. There were 30 patients (25.5%) in the RE group with minor postoperative complications versus the FE group with 40 patients (22.7%); and 1 patient (0.8%) in the RE group with severe complications versus the FE group with 5 paients (2.8%). Conclusion    Based on the analysis of this study, it is found that RE has higher safety. But the indications are strict, the professional requirements of the operator and the selection of patients are stronger. The FE is convenient to use, the operation crowd is wide, and the suitable crowd is wide. Therefore, for specific patients, after improving the relevant examination and preoperative evaluation of patients, clinicians need to choose appropriate surgical methods to ensure the success of the operation, and reduce the postoperative complications as far as possible.

Double Fogarty balloon catheter technique for difficult to retrieve esophageal foreign bodies.

BACKGROUND: Foreign body ingestion is common, especially in the pediatric population. Plans for retrieval should be tailored to the specific esophageal foreign bodies. CASE PRESENTATION: We present a difficult to retrieve esophageal foreign body in a 3-year-old girl who ingested a 2 cm glass pebble. Intraoperatively, attempts using conventional optical forceps and retrieval baskets were unsuccessful due to the size and smooth texture of the object. A novel strategy using double Fogarty embolectomy balloon catheters for retrieval of blunt esophageal foreign bodies was devised and described. CONCLUSION: The double fogarty retrieval technique described appeared to be safe and efficacious, allowing for extraction of large esophageal foreign bodies under direct visualization.

Esophageal foreign bodies in children: Emphasis on complicated cases.

BACKGROUND: Esophageal foreign bodies (EFBs) are a relatively common clinical problem in pediatric patients. The majority of EFBs pass harmlessly through the gastrointestinal tract; however, some EFBs can cause significant morbidities. This study was conducted to review our experience in managing esophageal foreign bodies in pediatric patients, with an emphasis on the management and outcomes of complicated cases. METHODS: Between March 1995 and March 2013, the records of all children up to the age of 12 years who were admitted to King Khalid University Hospital, Riyadh, Saudi Arabia, with a final diagnosis of EFBs were reviewed. The medical records were analyzed with respect to demographic data, presenting symptoms, workup investigation, management, complications, and outcomes. RESULTS: Seventy patients were identified (38 boys and 32 girls). The ages ranged from 5 days to 12 years (mean: 4.4 years). Fifty-three (75.7%) patients presented within 24 hours. Thirteen (18.6%) patients had underlying predisposing factors. The most common EFB, found in 30 (42.8%) patients, was a coin. Witnessed ingestion of a FB was documented in 52 (74.2%) patients. The most common symptoms were drooling of saliva in 42 (60%) patients, followed by vomiting in 36 (51.4%) patients. Four (5.7%) patients presented with complications secondary to FB impaction, including hypopharyngeal wall perforation, acquired esophageobronchial fistula, localized esophageal perforation with inflammation, and perforation with stricture formation. The follow-up period ranged from 2 to 12 months, and all patients had complete recovery without any sequelae. CONCLUSION: EFBs are a relatively common problem in pediatric patients, and underlying predisposing factors to EFB impaction are not uncommon. Long-retained EFBs are associated with a higher incidence of complications. Rigid esophagoscopy was successful in extracting most of the EFBs and was shown to be a safe and effective procedure.

Imaging findings of swallowed dentures: a case series.

Dental prosthesis is an uncommon ingested non-food foreign body in adults. Once swallowed, it can lead to serious complications and morbidity. Hence, early localization of the offending foreign body is crucial for timely management. As the dentures are usually made up of non-metallic material and often impacted at or below the level of C7 vertebra, conventional radiograph has limited role in their evaluation. We describe the clinical history and imaging findings of swallowed partial dentures in four patients who presented to the emergency department. The dentures were localized using unenhanced CT of the neck that showed the characteristic mildly hyperdense curvilinear or irregular appearance of the dentures within the upper esophagus. Multiplanar CT reconstructions provide an orientation of the ingested denture within the esophagus, thus guiding the endoscopist.

A New Trend in the Management of Esophageal Foreign Body: Transnasal Esophagoscopy.

OBJECTIVES: (1) To analyze the outcomes of patients with esophageal foreign body managed by transnasal esophagoscopy. (2) To review the value of lateral neck X-ray. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. SUBJECTS AND METHODS: Lateral neck X-ray was used for initial screening in patients suspected of having an esophageal foreign body between 2007 and 2013. Rigid esophagoscopy was used as standard for further investigations before July 2010 and transnasal esophagoscopy after July 2010. RESULTS: From January 2007 to June 2010, 43 patients who were suspected of having an esophageal foreign body under lateral neck X-ray received rigid esophagoscopy, 31 of whom were found to have an esophageal foreign body. From July 2010 to December 2013, 302 patients underwent transnasal esophagoscopy, and an esophageal foreign body was noted in only 52 of these patients. In the 302 patients who underwent transnasal esophagoscopy, the sensitivity and specificity of having an esophageal foreign body by lateral neck X-ray were 59% and 83%, respectively. CONCLUSION: The introduction of transnasal esophagoscopy has changed the diagnosis and management for an esophageal foreign body. Transnasal esophagoscopy is a quick and safe procedure that can be performed under local anesthesia. Transnasal esophagoscopy could replace lateral neck X-ray to become the initial screening procedure and a useful treatment for patients with an esophageal foreign body.

Prolonged Impacted Denture in the Esophagus: A Case Report and Review of the Literature.

Foreign body ingestion and aspiration is among the most common causes of emergency department visit associated with high morbidity and mortality. Ingested and aspirated denture is rare conditions being scarcely reported in the literature. We herein report a 57-year-old man who presented with 2-day history of liquid and solid dysphagia who was diagnosed to have impacted denture in esophagus since 3 years prior to presentation. He was diagnosed to have esophagus adenocarcinoma and had undergone esophageal radiotherapy. The denture was removed successfully using esophagoscopy and the patient was discharged after 48-hour care with good condition. To prevent accidental ingestion, dentures should be made to fit properly. Damaged or malfitting dentures should be discarded and replaced. Patients should be strongly advised against wearing them during sleep-time.

Management of foreign bodies of upper digestive tract.

The objective of this study was to determine the management of rigid esophagoscopy for extraction of foreign bodies (FBs) upper digestive tract in a tertiary care hospital. This descriptive study was conducted at the Department of ENT, Head and Neck Surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from January 2008 to December 2010. This study included 380 patients. After taking detailed history, thorough examination and investigations, a well informed consent was obtained. Rigid esophagoscopy was performed under general anesthesia. The data was analyzed using the statistical program for social sciences (SPSS version 17). Our study with total duration of 3 years included 380 cases constituting 227 male and 153 female, with male:female ratio of 1.48:1. The age of the patients ranged from 1 to 80 years with mean age of 39.39 ± SD 6.81 years. The clinical features of these patients were mainly dysphagia for solids (72.89%) followed by throat pain (18.15%). Site of impaction of FBs was that in 303 cases (79.73%) cricopharynx, in 61 cases (16.05%) mid-esophagus and in 16 cases (4.21%) pyriform fossa was involved. Rigid esophagoscopy was performed in all cases and a variety of FB was extracted from upper digestive tract. The commonest FB was coin 58.42% followed by meat bolus 17.10%. It is concluded from this study that the commonest FB upper digestive tract in children is coin while in adults is meat bolus in this part of the world. Rigid esophagoscopy is still the technique of choice for its extraction and its complication can be minimized if performed by expert hands.

Yield of chest radiography after removal of esophageal foreign bodies.

OBJECTIVES: The aim of this study was to determine the benefit of routine postoperative chest radiography after removal of esophageal foreign bodies in children. METHODS: Medical records were reviewed of all patients evaluated with an esophageal foreign body at a single children's hospital over 10 years. Operative records and imaging reports were reviewed for evidence of esophageal injury. RESULTS: Of 803 records identified, 690 were included. All underwent rigid esophagoscopy and foreign body removal. The most common items removed were coins (94%), food boluses (3%), and batteries (2%). The rate of esophageal injury was 1.3% (9 patients). No injuries were identified on chest radiographs done as routine or for concern of injury. Patients with operative findings suggestive of an esophageal injury (n = 105) were significantly more likely to have an injury (8.6% vs 0%, P = .0001). Of the 585 children who did not have physical evidence of injury, 40% (n = 235) received a routine chest radiograph. Regardless of the indication, no injuries were identified on chest films. CONCLUSIONS: We conclude that intraoperative findings during rigid esophagoscopy suggestive of an injury are predictive of esophageal perforation. Routine chest radiography is not warranted in children who do not meet this criterion. In patients with a concern for injury, we suggest that chest radiography should be deferred in favor of esophagram.

Esophageal tear after removal of pin ended earrings from hypopharynx of a child: Case report and review of the literature.

This report describes an interesting case of pin-ended earring, a foreign body, in a child, which could not be manipulated by rigid esophagoscope. The surgeon was able to extract it, on the suggestion of the anesthesiologist, by Magill forceps. Examination of the site of impaction of FB showed a small tear attributed to penetration of pin end of the earring. The pediatric surgeon, on post-procedure consultation, advised to follow-up the patient in pediatric intensive care unit with antibiotic prophylaxis. Chest radiograph on the following days showed opacity in the upper right chest region, which was cleared on the fourth post-operative day. This paper describes the anesthetic and operative procedural manipulations that led to safe outcome.