We report on our novel technique for endoscopic removal of sharp needles from the
duodenum. A 43-year-old woman was referred to our hospital after attempting suicide
by swallowing sewing needles. Endoscopy revealed the presence of five needles in the
duodenum, with the tips lodged in the duodenal wall (Figure [1]). Four of the five needles were removed safely using a snare and grasping forceps
(SD11L-1, FG-17K-1; Olympus, Tokyo, Japan) through an overtube in the esophagus. The
fifth needle had penetrated through the pylorus into the stomach during the procedure.
To remove it without further injury, we used forceps (FB-21K-1; Olympus) through the
sheath normally used for a clip device (HX-5LR-1; Olympus). After placing the needle
completely within the sheath, we were able to remove the needle through the forceps
channel easily and safely (Figure [2]).
Figure 1 Endoscopic view of the duodenum. The needle had become stuck in the wall of the duodenum.
Figure 2 a Forceps were inserted through the sheath of a clip device. b The head of the neddle was grasped with the forceps. c The entire needle was drawn into the sheath. d The sheath and needle were removed through the forceps channel of the endoscope.
To remove ingested foreign bodies, endoscopic approaches are generally less invasive
than surgical intervention. However, extreme caution is required when the foreign
body is sharp, as it is easy to injure the wall of the gastrointestinal tract. One
method involves using an overtube to protect the esophagus during repeated insertion
and withdrawal of the endoscope [1]
[2]. Another technique involves fashioning a protective hood for the endoscope using
variety of devices, such as soft latex protector hoods [3]
[4]. Using the endoscopic approach shown here, we were able to remove the needles without
complication.
For this procedure, we used grasping forceps through the sheath normally used for
a clip device. The fifth needle was placed within the sheath, and was covered completely.
Thus, all the needles were taken out through the forceps channel without repeating
insertion of the endoscope itself. If the endoscope can reach the site, it is possible
to remove sharp foreign bodies from the gastrointestinal tract. Our technique allowed
easy and safe endoscopic removal of the sharp needles.
Endoscopy_UCTN_Code_TTT_1AO_2AL
