Current Treatment Options in Gastroenterology

, Volume 9, Issue 1, pp 75–84 | Cite as

Esophageal foreign bodies: Types and techniques for removal

  • Milton T. Smith
  • Roy K. H. Wong

Opinion statement

Patients with esophageal foreign bodies require prompt diagnosis and therapy. The first tasks are to determine the type of object, time since ingestion, location of the object, and the likelihood of associated complications. Patients who have evidence of complete esophageal occlusion or who have ingested a sharp or pointed object require urgent treatment due to the increased risk of complications. Button batteries are particularly injurious in the esophagus and should be removed immediately. Coins in the esophagus should also be removed; however, a brief period of observation is appropriate for coins in the distal esophagus, as some will pass spontaneously. Flexible endoscopy is the therapeutic modality of choice for most patients. The key principles for endoscopic management of esophageal foreign bodies are to protect the airway, to maintain control of the object during extraction, and to avoid causing additional damage. Endotracheal intubation is sometimes necessary, especially in younger children and those at higher risk for aspiration. The use of devices such as an esophageal overtube and a latex protector hood may facilitate safer extraction of sharp/pointed objects. Patients with food impactions usually require treatment of an associated structural lesion of the esophagus.


Foreign Body Esophageal Perforation Eosinophilic Esophagitis Food Bolus Food Impaction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Cheng W, Tam PK: Foreign-body ingestion in children: experience with 1,265 cases. J Pediatr Surg 1999, 34:1472–1476.PubMedCrossRefGoogle Scholar
  2. 2.
    Hachimi-Idrissi S, Corne L, Vandenplas Y: Management of ingested foreign bodies in childhood: our experience and review of the literature. Eur J Emerg Med 1998, 5:319–323.PubMedGoogle Scholar
  3. 3.
    Webb WA: Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc 1995, 41:39–51.PubMedCrossRefGoogle Scholar
  4. 4.
    Simic MA, Budakov BM: Fatal upper esophageal hemorrhage caused by a previously ingested chicken bone: case report. Am J Forensic Med Pathol 1998, 19:166–168.PubMedCrossRefGoogle Scholar
  5. 5.
    Bennett DR, Baird CJ, Chan KM, et al.: Zinc toxicity following massive coin ingestion. Am J Forensic Med Pathol 1997, 18:148–153.PubMedCrossRefGoogle Scholar
  6. 6.
    Duncan M, Wong RK: Esophageal emergencies: things that will wake you from a sound sleep. Gastroenterol Clin North Am 2003, 32:1035–1052. A comprehensive review of important esophageal emergencies encountered by endoscopists, including caustic ingestions, foreign bodies, and esophageal perforation.PubMedCrossRefGoogle Scholar
  7. 7.
    Longstreth GF, Longstreth KJ, Yao JF: Esophageal food impaction: epidemiology and therapy. A retrospective, observational study. Gastrointest Endosc 2001, 53:193–198. An informative study of food impactions in a large series of adult patients. Key clinical features and outcomes of therapy are provided.PubMedCrossRefGoogle Scholar
  8. 8.
    Vizcarrondo FJ, Brady PG, Nord HJ: Foreign bodies of the upper gastrointestinal tract. Gastrointest Endosc 1983, 29:208–210.PubMedGoogle Scholar
  9. 9.
    Nandi P, Ong GB: Foreign body in the oesophagus: review of 2394 cases. Br J Surg 1978, 65:5–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Yeaton P, Peura D: Foreign bodies. In The Esophagus. Edited by Castell D, Richter J. Philadelphia: Lippincott Williams & Wilkins; 1999:340–353.Google Scholar
  11. 11.
    Benjamin S, Noguera E: Foreign bodies. In The Esophagus, edn 4. Edited by Castell D, Richter J. Philadelphia: Lippincott Williams & Wilkins; 2004:340–353. This recently published chapter thoroughly covers the evaluation and available treatment options for esophageal forein bodies.Google Scholar
  12. 12.
    Vicente Y, Hernandez-Peredo G, Molina M, et al.: Acute food bolus impaction without stricture in children with gastroesophageal reflux. J Pediatr Surg 2001, 36:1397–1400.PubMedCrossRefGoogle Scholar
  13. 13.
    Shah SW, Khan AA, Alam A, et al.: Esophageal bezoar in achalasia: a rare condition. J Clin Gastroenterol 1997, 25:395–396.PubMedCrossRefGoogle Scholar
  14. 14.
    Katz P, Castell J: Nonachalasia motility disorders. In The Esophagus, edn 3. Edited by Castell D, Richter J. Philadelphia: Lippincott Williams & Wilkins; 1999:215–234.Google Scholar
  15. 15.
    Breumelhof R, Van Wijk HJ, Van Es CD, Smout AJ: Food impaction in nutcracker esophagus. Dig Dis Sci 1990, 35:1167–1171.PubMedCrossRefGoogle Scholar
  16. 16.
    Mazzadi S, Salis GB, Garcia A, et al.: Foreign body impaction in the esophagus: Are there underlying motor disorders? Dis Esophagus 1998, 11:51–54.PubMedGoogle Scholar
  17. 17.
    Desai TK, Stecevic V, Chang CH, et al.: Association of eosinophilic inflammation with esophageal food impaction in adults. Gastrointest Endosc 2005, 61:795–801. This study highlights the importance of recognizing eosinophilic esophagitis in adults who present with acute esophageal food impaction.PubMedCrossRefGoogle Scholar
  18. 18.
    Croese J, Fairley SK, Masson JW, et al.: Clinical and endoscopic features of eosinophilic esophagitis in adults. Gastrointest Endosc 2003, 58:516–522.PubMedCrossRefGoogle Scholar
  19. 19.
    Potter JW, Saeian K, Staff D, et al.: Eosinophilic esophagitis in adults: an emerging problem with unique esophageal features. Gastrointest Endosc 2004, 59:355–361.PubMedCrossRefGoogle Scholar
  20. 20.
    Chen MK, Beierle EA: Gastrointestinal foreign bodies. Pediatr Ann 2001, 30:736–742.PubMedGoogle Scholar
  21. 21.
    Uyemura MC: Foreign body ingestion in children. Am Fam Physician 2005, 72:287–291.PubMedGoogle Scholar
  22. 22.
    Kim JK, Kim SS, Kim JI, et al.: Management of foreign bodies in the gastrointestinal tract: an analysis of 104 cases in children. Endoscopy 1999, 31:302–304.PubMedCrossRefGoogle Scholar
  23. 23.
    Kikendall J: Pill-induced esophageal injury. In The Esophagus, edn 4. Edited by Castell D, Richter J. Philadelphia: Lippincott William & Wilkins; 2004:572–584.Google Scholar
  24. 24.
    Herranz-Gonzalez J, Martinez-Vidal J, Garcia-Sarandeses A, Vazquez-Barro C: Esophageal foreign bodies in adults. Otolaryngol Head Neck Surg 1991, 105:649–654.PubMedGoogle Scholar
  25. 25.
    Webb WA, Taylor M: Foreign bodies of the upper gastrointestinal tract. In Gastrointestinal Emergencies, edn 2. Edited by Taylor M. Baltimore: Williams & Wilkins; 1997:3–19.Google Scholar
  26. 26.
    Johnston B, Castell D: Symptom overview and quality of life. In The Esophagus. Edited by Castell D, Richter J. Philadelphia: Lippincott Williams & Wilkins; 2004:37–46.Google Scholar
  27. 27.
    Wilcox CM, Alexander LN, Clark WS: Localization of an obstructing esophageal lesion. Is the patient accurate? Dig Dis Sci 1995, 40:2192–2196.PubMedCrossRefGoogle Scholar
  28. 28.
    Roeder BE, Murray JA, Dierkhising RA: Patient localization of esophageal dysphagia. Dig Dis Sci 2004, 49:697–701.PubMedCrossRefGoogle Scholar
  29. 29.
    Ginsberg GG: Management of ingested foreign objects and food bolus impactions. Gastrointest Endosc 1995, 41:33–38.PubMedCrossRefGoogle Scholar
  30. 30.
    Bassett KE, Schunk JE, Logan L: Localizing ingested coins with a metal detector. Am J Emerg Med 1999, 17:338–341.PubMedCrossRefGoogle Scholar
  31. 31.
    Gooden EA, Forte V, Papsin B: Use of a commercially available metal detector for the localization of metallic foreign body ingestion in children. J Otolaryngol 2000, 29:218–220.PubMedGoogle Scholar
  32. 32.
    Takada M, Kashiwagi R, Sakane M, et al.: 3D-CT diagnosis for ingested foreign bodies. Am J Emerg Med 2000, 18:192–193.PubMedCrossRefGoogle Scholar
  33. 33.
    Eliashar R, Dano I, Dangoor E, et al.: Computed tomography diagnosis of esophageal bone impaction: a prospective study. Ann Otol Rhinol Laryngol 1999, 108:708–710.PubMedGoogle Scholar
  34. 34.
    Silva RG, Ahluwalia JP: Asymptomatic esophageal perforation after foreign body ingestion. Gastrointest Endosc 2005, 61:615–619.PubMedCrossRefGoogle Scholar
  35. 35.
    Lim CC, Cheah FK, Tan JC: Spiral computed tomography demonstration of aorto-oesophageal fistula from fishbone. Clin Radiol 2000, 55:976–977.PubMedCrossRefGoogle Scholar
  36. 36.
    Faigel DO, Stotland BR, Kochman ML, et al.: Device choice and experience level in endoscopic foreign object retrieval: an in vivo study. Gastrointest Endosc 1997, 45:490–492.PubMedCrossRefGoogle Scholar
  37. 37.
    EisenGM, Baron TH, Dominitz JA, et al.: Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002, 55:802–806. This article is the current practice guideline published by the American Society for Gastrointestinal Endoscopy. It is concise, easy to read, and gives recommendations based upon large series and reports from recognized experts on the subject.PubMedCrossRefGoogle Scholar
  38. 38.
    Chaves DM, Ishioka S, Felix VN, et al.: Removal of a foreign body from the upper gastrointestinal tract with a flexible endoscope: a prospective study. Endoscopy 2004, 36:887–892.PubMedCrossRefGoogle Scholar
  39. 39.
    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.PubMedCrossRefGoogle Scholar
  40. 40.
    Pezzi JS, Shiau YF: A method for removing meat impactions from the esophagus. Gastrointest Endosc 1994, 40:634–636.PubMedCrossRefGoogle Scholar
  41. 41.
    Nijhawan S, Rai RR, Nepalia S, Pokharna R: Suction retrieval of esophageal foreign bodies. Endoscopy 1998, 30:S59.PubMedCrossRefGoogle Scholar
  42. 42.
    Kozarek R, Ball T, Belic L, et al.: Food impaction at a regional referral center: Should we push? Pull? or Poke? Gastrointest Endosc 1999, 49:AB113.Google Scholar
  43. 43.
    Vicari JJ, Johanson JF, Frakes JT: Outcomes of acute esophageal food impaction: success of the push technique. Gastrointest Endosc 2001, 53:178–181. This study evaluates the efficacy and safety of the "push" technique for endoscopic management of food impactions. The safety of same session esophageal dilations is also reported.PubMedCrossRefGoogle Scholar
  44. 44.
    Gluck M, Schembre DB, Kozarek RA: A concern with use of the "push technique" in patients with multiple esophageal rings. Gastrointest Endosc 2001, 54:543–544.PubMedCrossRefGoogle Scholar
  45. 45.
    Alaradi O, Bartholomew M, Barkin JS: Upper endoscopy and glucagon: a new technique in the management of acute esophageal food impaction. Am J Gastroenterol 2001, 96:912–913.PubMedCrossRefGoogle Scholar
  46. 46.
    Colon V, Grade A, Pulliam G, et al.: Effect of doses of glucagon used to treat food impaction on esophageal motor function of normal subjects. Dysphagia 1999, 14:27–30.PubMedCrossRefGoogle Scholar
  47. 47.
    Nelson DB, Bosco JJ, Curtis WD, et al.: ASGE technology status evaluation report. Endoscopic retrieval devices. February 1999. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999, 50:932–934.PubMedCrossRefGoogle Scholar
  48. 48.
    Waltzman ML, Baskin M, Wypij D, et al.: A randomized clinical trial of the management of esophageal coins in children. Pediatrics 2005, 116:614–619.PubMedCrossRefGoogle Scholar
  49. 49.
    Bonadio WA, Jona JZ, Glicklich M, Cohen R: Esophageal bougienage technique for coin ingestion in children. J Pediatr Surg 1988, 23:917–918.PubMedCrossRefGoogle Scholar
  50. 50.
    Gauderer MW, DeCou JM, Abrams RS, Thomason MA: The "penny pincher": a new technique for fast and safe removal of esophageal coins. J Pediatr Surg 2000, 35:276–278.PubMedCrossRefGoogle Scholar
  51. 51.
    Mosca S, Manes G, Martino R, et al.: Endoscopic management of foreign bodies in the upper gastrointestinal tract: report on a series of 414 adult patients. Endoscopy 2001, 33:692–696.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  • Milton T. Smith
    • 1
  • Roy K. H. Wong
  1. 1.Walter Reed Army Medical CenterWashington, DCUSA

Personalised recommendations