CC BY-NC-ND 4.0 · Endoscopy
DOI: 10.1055/a-1816-8110
E-Videos

Endoscopic removal of an embedded esophageal fishbone with rat tooth forceps

Jin Yu Wu
Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, P. R. China
,
Li Jiang
Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, P. R. China
,
Bo Yu Ma
Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, P. R. China
,
Huan Xv
Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, P. R. China
,
Chuan Kang Tang
Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, P. R. China
,
Lei Shi
Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, P. R. China
› Author Affiliations

A 56-year-old woman presented to our hospital with a sore throat after having eaten a fish 15 days earlier. Computed tomography (CT) revealed a strip of high-density shadow embedded in the anterior wall of the proximal esophagus. Endoscopy only demonstrated a localized bulge of the esophagus with smooth mucosa ([Fig. 1]). Endoscopic ultrasonography suggested a hyperechoic lesion in the esophageal submucosa with posterior shadowing ([Fig. 2]). Based on these examinations, a diagnosis of fishbone invasion into the esophageal submucosa was considered, so we performed an endoscopic submucosal dissection (ESD) but failed to find the fishbone. We therefore attempted to find the fishbone using a rat tooth forceps, and this was successful ([Fig. 3]). A 2-cm-long fishbone was extracted with the forceps ([Fig. 4]) and the wound was clamped closed with several metal clips ([Video 1]).

Zoom Image
Fig. 1 Oval-shaped submucosal bulge in the esophageal mucosa of a 56-year-old woman: the fishbone cannot be seen.
Zoom Image
Fig. 2 Endoscopic ultrasonography revealed the location and depth of the fishbone.
Zoom Image
Fig. 3 The fishbone was successfully found using a rat tooth forceps.
Zoom Image
Fig. 4 The fishbone.

Video 1 Endoscopic removal of an embedded esophageal fishbone with rat tooth forceps.


Quality:

A fishbone invading the submucosa and intrinsic muscular layer of the esophagus is rare. Endoscopy commonly suggests a submucosal bulge, which is easily misdiagnosed as a malignant tumor [1]. To manage such cases, ESD after the foreign body has been accurately located under EUS guidance is usually effective [2]. However, in our case, ESD failed to find the fishbone under EUS guidance; instead, the fishbone was found and smoothly removed using the rat tooth forceps.

In conclusion, rat tooth forceps may be a good choice to find a fishbone that remains hidden after ESD.

Endoscopy_UCTN_Code_CCL_1AB_2AZ

Endoscopy E-Videos
https://eref.thieme.de/e-videos

Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available.

This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos



Publication History

Article published online:
13 May 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany