A novel technique for endoscopic removal of foreign bodies using a balloon and transparent cap

The presence of foreign bodies in the esophagus is a common clinical emergency and induces discomfort in patients, including chest pain or dysphagia, but may also result in more severe complications, such as hemorrhage and esophageal perforation [1]. We report a novel method of removing large foreign bodies using a balloon with the assistance of a transparent cap.

A 68-year-old woman was referred to our department complaining of chest pain following ingestion of a round-shaped stone 3 days earlier. On computed tomography scan, a high-density object approximately 3 cm in length was observed in the mid-esophagus ([Fig. 1]). Multiple attempts to remove the stone failed ([Fig. 2]). Therefore, we developed a new retrieval method using a transparent cap and dilation balloon (Vedkang, Changzhou, China) ([Fig. 3]). The deflated balloon, together with a transparent cap, was attached to the distal end of the endoscope, and then inserted into the esophagus. Subsequently, once the end of the endoscope reached the foreign body, 20 mL of air was injected into the balloon through a thin catheter, expanding its outer diameter from 1.3 to 3.5 cm. As the balloon was inflated, the narrow esophageal lumen gradually dilated, allowing the stone to be pushed into the stomach. The stone was eventually extracted using a disposable polypectomy snare ([Fig. 4]). Mild hematoma and mucosal injury were observed at the original site of the stone, without perforation, infection, or other complications ([Fig. 5], [Video 1]).

Fig. 1 A high-density object, approximately 3 cm in length on the computed tomography scan, was observed in the mid-esophagus.

Fig. 2 Although various attempts were made using different methods, the stone remained in the esophagus.

Fig. 3 A self-designed balloon, together with a transparent cap, was attached to the distal end of the endoscope and inflated with 20 mL of air, expanding its outer diameter from 1.3 cm to 3.5 cm.

Fig. 4 The round-shaped stone was extracted using a disposable polypectomy snare after being pushed into the stomach.

Fig. 5 Mild hematoma and mucosal injury were observed at the original site of the stone, but without perforation, infection, or other complications.

Video 1 A novel technique for endoscopic removal of foreign bodies using a balloon and transparent cap.

The balloon was originally designed for endoscopic injection sclerotherapy to treat esophageal variceal hemorrhage [2]. We demonstrated that this approach was also safe, simple, and highly effective for extraction of foreign bodies in the esophagus, particularly for large or sharp objects. Thus, we highly recommend balloon-assisted endoscopy as a feasible technique worthy of clinical promotion.

Endoscopy_UCTN_Code_TTT_1AO_2AL

Publication History

Article published online:
20 April 2021

• References

• 1 Triadafilopoulos G, Roorda A, Akiyama J. Update on foreign bodies in the esophagus: diagnosis and management. Curr Gastroenterol Rep 2013; 15: 317
• 2 Mei X, Wang X, Wu W. et al. Balloon-assisted endoscopic sclerotherapy: a novel technology. Endoscopy 2020; DOI: 10.1055/a-1290-7001.