Case of the Month: Foreign Body Removal Using Modified Over tube

CONTRIBUTED BY:

Dr Srisha Hebbar

Consultant Gastroenterologist University Hospitals of North Midlands United Kingdom

A young male presented to the emergency department with odynophagia and retrosternal discomfort after accidentally swallowing a vape device.

Endoscopic removal was attempted, but negotiating the gastroesophageal junction proved challenging due to the size and rigidity of the object.

To facilitate safe retrieval, an over tube was deployed after modification .

Two longitudinal slits were made on the distal end of the over tube using scissors, creating flexible flaps that could partially accommodate and stabilise the foreign body during extraction.

The vape was securely captured with a snare, and its distal end was gently guided into the slits of the overtube. With steady and controlled traction on the snare catheter, the overtube and foreign body were jointly withdrawn through the esophagus and out of the oropharynx.

The patient tolerated the procedure well with no immediate complications, and post-removal endoscopy showed no evidence of mucosal injury or perforation.

The patient was observed for a short period and subsequently discharged with advice on avoiding oral contact with non-edible objects.

References:

1. 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(5):489–496.
2. ASGE Standards of Practice Committee, Ikenberry SO, Jue TL, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc. 2011;73(6):1085–1091.
3. Athanassiadi K, Gerazounis M, Metaxas E, Kalantzi N. Management of esophageal foreign bodies: a retrospective review of 400 cases. Eur J Cardiothorac Surg. 2002;21(4):653–656.