Skip to main content
SpringerLink
Log in

Cap-Assisted Endoscopic Esophageal Foreign Body Removal Is Safe and Efficacious Compared to Conventional Methods

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Introduction

Esophageal foreign body impaction (FBI) is a commonly encountered gastrointestinal emergency requiring immediate intervention. Foreign bodies can be composed of food, commonly referred to as a "food bolus" (FB), or other matter (non-food). We aim to conduct systematic review and meta-analysis to compare cap-assisted and conventional endoscopic techniques for removal of esophageal FBI.

Methods

A comprehensive search technique was utilized to identify studies that used capped endoscopic devices to remove FB or other esophageal foreign bodies. The primary outcomes were the technical success rate, rate of en bloc retrieval, and procedure time. Secondary outcomes were overall adverse events, bleeding, mucosal tears, and perforation.

Results

Seven studies with a total of 1407 patients were included. The mean patient age was 55.3 (SD ± 7.2) years and 44.8% of patients were male. There were two RCTs and five observational studies among the included studies. The technical success rate was significantly higher in the cap-assisted group compared to the conventional group (OR 3.47, CI 1.68–7.168, I2 = 0%, p =  < 0.001), as well as the en bloc retrieval rate (OR 26.90, CI 17.82–40.60, I2 = 0%, p = 0.001). There was a trend towards lower procedural time for the cap-assisted group compared to the conventional group, although the difference did not reach statistical significance (MD − 10.997, CI − 22.78–0.786, I2 = 99.9%, p = 0.06). The overall adverse events were significantly lower in the cap-assisted group compared to the conventional group (OR 0.118, CI 0.018–0.792, I2 = 81.79%, p = 0.02).

Conclusion

The cap-assisted technique has improved efficacy and safety. To confirm these results, larger randomized trials are warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

CI:

Confidence interval

EGD:

Esophagogastroduodenoscopy

FB:

Food bolus

FBI:

Foreign body impaction

MD:

Mean difference

OR:

Odds ratio

RCT:

Randomized control trial

References

  1. Mitrović SM, Karan S, Karan JV, Vucinić P. Oesophageal food bolus impaction in elderly people. Med Pregl 2014;67:33–37.

    Article  PubMed  Google Scholar 

  2. Geraci G, Sciume' C, Di Carlo G, Picciurro A, Modica G. Retrospective analysis of management of ingested foreign bodies and food impactions in emergency endoscopic setting in adults. BMC Emerg Med 2016;16:42.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Berggreen PJ, Harrison E, Sanowski RA, Ingebo K, Noland B, Zierer S. Techniques and complications of esophageal foreign body extraction in children and adults. Gastrointest Endosc 1993;39:626–630.

    Article  CAS  PubMed  Google Scholar 

  4. Katsinelos P, Kountouras J, Paroutoglou G, Zavos C, Mimidis K, Chatzimavroudis G. Endoscopic techniques and management of foreign body ingestion and food bolus impaction in the upper gastrointestinal tract: a retrospective analysis of 139 cases. J Clin Gastroenterol 2006;40:784–789.

    Article  PubMed  Google Scholar 

  5. Chauvin A, Viala J, Marteau P, Hermann P, Dray X. Management and endoscopic techniques for digestive foreign body and food bolus impaction. Dig Liver Dis 2013;45:529–542.

    Article  PubMed  Google Scholar 

  6. Leopard D, Fishpool S, Winter S. The management of oesophageal soft food bolus obstruction: a systematic review. Ann R Coll Surg Engl 2011;93:441–444.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Leong AC, Mitchell DB. Endoscopic management of oesophageal food bolus obstruction: flexibility is the way forward. Eur Arch Otorhinolaryngol 2008;265:493–494 (author reply 495).

    Article  CAS  PubMed  Google Scholar 

  8. Weinstock LB, Shatz BA, Thyssen SE. Esophageal food bolus obstruction: evaluation of extraction and modified push techniques in 75 cases. Endoscopy 1999;31:421–425.

    Article  CAS  PubMed  Google Scholar 

  9. Ooi M, Duong T, Holman R, et al. Comparison of cap-assisted vs conventional endoscopic technique for management of food bolus impaction in the esophagus: results of a multicenter randomized controlled trial. Am J Gastroenterol 2021;116:2235–2240.

    Article  PubMed  Google Scholar 

  10. Zhang S, Wang J, Wang J, Zhong B, Chen M, Cui Y. Transparent cap-assisted endoscopic management of foreign bodies in the upper esophagus: a randomized, controlled trial. J Gastroenterol Hepatol 2013;28:1339–1342.

    Article  PubMed  Google Scholar 

  11. Chiu KW, Lu LS, Wu TC, Chiou SS. Novel low-cost endoscopic cap for esophageal foreign objects: a case report. Medicine (Baltimore) 2015;94:e796.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003;73:712–716.

    Article  PubMed  Google Scholar 

  13. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj 2011;343:d5928.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Zhao G. The analysis of treatment effect of transparent cap-assisted endoscopic esophageal foreign body removal. J Dig. Dis 2017;18:162–163.

    Google Scholar 

  15. Zhang S, Cui Y, Gong X, Gu F, Chen M, Zhong B. Endoscopic management of foreign bodies in the upper gastrointestinal tract in south China: a retrospective study of 561 cases. Dig. Dis. Sci. 2010;55:1305–1312.

    Article  PubMed  Google Scholar 

  16. Ooi M, Young EJ, Nguyen NQ. Effectiveness of a cap-assisted device in the endoscopic removal of food bolus obstruction from the esophagus. Gastrointest. Endosc. 2018;87:1198–1203.

    Article  PubMed  Google Scholar 

  17. Ooi M, Duong T, Holman R, et al. Advantages of a cap-assisted device in the endoscopic management of food bolus obstruction in the esophagus: a multicenter randomized controlled trial. J. Gastroenterol. Hepatol. 2019;34:8.

    Google Scholar 

  18. Wahba M, Habib G, Mazny AE, et al. Cap-assisted technique versus conventional methods for esophageal food bolus extraction: a comparative study. Clin. Endosc. 2019;52:458–463.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wahba M, Habib G, Mazny AE, et al. Cap-assisted technique versus conventional methods for esophageal food bolus extraction: a comparative study. Clin Endos 2019;52:458–463.

    Article  Google Scholar 

  20. Ooi M, Young EJ, Nguyen NQ. Effectiveness of cap-assisted device in the endoscopic management of food bolus obstruction in the upper esophagus. United Eur Gastroenterol J 2017;5:A579.

    Google Scholar 

  21. Fang R, Cao B, Zhang Q, Li P, Zhang ST. The role of a transparent cap in the endoscopic removal of foreign bodies in the esophagus: A propensity score-matched analysis. J Dig Dis 2020;21:20–28.

    Article  PubMed  Google Scholar 

  22. Eisen GM, Baron TH, Dominitz JA et al. Guideline for the management of ingested foreign bodies. Gastrointest Endosc 1995;42:622–625.

    Article  Google Scholar 

  23. Magalhães-Costa P, Carvalho L, Rodrigues JP, et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract: an evidence-based review article. GE Port J Gastroenterol 2016;23:142–152.

    Article  PubMed  Google Scholar 

  24. Ooi M, Young EJ, Nguyen NQ. Effectiveness of a cap-assisted device in the endoscopic removal of food bolus obstruction from the esophagus. Gastrointest Endosc 2018;87:1198–1203.

    Article  PubMed  Google Scholar 

  25. Tang QL, Su JK, Wu HH, Li XL, Zhang MQ. Endoscopic management of foreign bodies in the upper-GI tract: a study with 357 cases [Conference Abstract]. J Digest Dis 2015;16:136.

    Google Scholar 

  26. Zhao G. The analysis of treatment effect of transparent cap-assisted endoscopic esophageal foreign body removal. J Digest Dis 2017;18:26–29.

    Google Scholar 

  27. Birk M, Bauerfeind P, Deprez PH, et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016;48:489–496.

    Article  PubMed  Google Scholar 

  28. Ko HH, Enns R. Review of food bolus management. Can J Gastroenterol 2008;22:805–808.

    Article  PubMed  PubMed Central  Google Scholar 

  29. von Hippel PT. The heterogeneity statistic I2 can be biased in small meta-analyses. BMC Med Res Methodol 2015;15:35.

    Article  Google Scholar 

  30. Chávez Rossell M. New technique for safe removal of impacted foreign bodies in the upper gastrointestinal tract using reusable variceal “cap” (cup, cap or cylinder). Revista de gastroenterología del Perú 2012;32:150–156.

    PubMed  Google Scholar 

  31. Ilavarasi, Sheikh K, Kini R, Premkumar K, Pugazhendhi T, Ali M. Analysis of foreign bodies in the gastrointestinal tract. Indian J Gastroenterol 2014;33:A107.

    Google Scholar 

  32. Wu W, Han Y, Kong D. A novel technique for endoscopic removal of foreign bodies using a balloon and transparent cap. Endoscopy 2022;54:E149–E150.

    Article  PubMed  Google Scholar 

  33. Yuan F, Tang X, Gong W, Su L, Zhang Y. Endoscopic management of foreign bodies in the upper gastrointestinal tract: an analysis of 846 cases in China. Exp Ther Med 2018;15:1257–1262.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA

    Zohaib Ahmed

  2. Dow University of Health Sciences, Karachi, Pakistan

    Syeda Faiza Arif

  3. University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA

    Stephanie Lin Ong & Joyce Badal

  4. University of Toledo Libraries, University of Toledo, Toledo, OH, USA

    Wade Lee-Smith

  5. Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA

    Anas Renno, Yaseen Alastal, Ali Nawras & Muhammad Aziz

Authors
  1. Zohaib Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Syeda Faiza Arif
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephanie Lin Ong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joyce Badal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wade Lee-Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anas Renno
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yaseen Alastal
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ali Nawras
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Muhammad Aziz
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ZA—study planning and conduction, data collection and interpretation, manuscript drafting and revision. SFA—data collection, manuscript drafting. SLO—manuscript drafting and revision. JB—data collection, manuscript drafting and revision. WLS—search strategy and systematic review, data collection, manuscript drafting. AR, YA, AN, MA—study design and conception, critical revision of the manuscript.

Corresponding author

Correspondence to Zohaib Ahmed.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

No human subjects or animals were involved in this systematic review and meta-analysis. No funding was received for the preparation of this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Full Search Strategy and PRISMA Checklist. Supplementary file1 (DOCX 15 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahmed, Z., Arif, S.F., Ong, S.L. et al. Cap-Assisted Endoscopic Esophageal Foreign Body Removal Is Safe and Efficacious Compared to Conventional Methods. Dig Dis Sci 68, 1411–1425 (2023). https://doi.org/10.1007/s10620-022-07741-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-022-07741-z

Keywords

Search

Navigation