Creating ‘space’ for retrieval of a large foreign body

Endoscopists frequently encounter impacted foreign bodies in the oesophagus, which require urgent intervention. Impaction mostly occurs at sites of physiological narrowing and angulations of the oesophagus or at sites of oesophageal stricture or within an oesophageal diverticulum. Dentures, fish, and mutton bolus (steak house syndrome) are common impacted oesophageal foreign bodies in an adult [1]. We present a unique retrieval technique of a large, impacted denture within the mid oesophagus.
An gentleman aged 72 years with no co-morbidity had accidentally ingested an artificial denture 48 h prior to admission and had severe dysphagia and odynophagia. He had no respiratory distress, gastrointestinal bleeding, chest pain or discomfort, cough, or aspiration. At upper gastrointestinal endoscopy, the cricopharynx was grossly oedematous. The denture was dislodged gently using rat tooth forceps and manoeuvred into the stomach. This resulted in surface mucosal ulceration and minimal bleeding. The patient was observed for the next 48 h for any complication. On day 3, a check-up X-ray of the abdomen was taken, confirming its location within the gastric lumen. A repeat endoscopy was attempted, under sedation and airway protection, for denture retrieval after informed consent was obtained explaining the risks involved in its retrieval. At endoscopy, there was a significant reduction in cricopharyngeal oedema.
Anticipating problems in retrieving the denture at the cricopharynx, a consensus was reached to create an additional space around the cricopharynx using a controlled radial expansion (CRE) balloon. In the first instance, the denture was held with rat tooth forceps. A CRE balloon was channelled over a guide wire into the stomach. The balloon was placed in close proximity to the endoscope and slightly proximal to the forceps grasping the denture, and both were steered proximally under fluoroscopy guidance. At the cricopharynx, the CRE was inflated to 12 mm, thus creating an additional space, which helped in retrieving the denture with ease (Figure 1). Post procedure was uneventful, and the patient was discharged a day later. Impacted foreign bodies within the oesophagus may lie free within the lumen or can be buried deep in the mucosal or muscular layer of the oesophagus. The latter leads to mucosal oedema, and ulceration progressing to penetration and perforation. Other complications include mediastinitis, para- or retropharyngeal abscess,...


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