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New Delhi, February 24, 2023:
The use of upper gastrointestinal endoscopy for removal of foreign objects in stomach is a common practice, especially in children. You must have heard of infants and toddlers swallowing coins, toy battery cells, small magnets, drawing pins etc. which are removed endoscopically. In elderly adults inadvertently swallowed dentures are frequently encountered foreign bodies which require emergency endoscopic intervention. Gastroenterologists at the Institute of Liver, Gastroenterology and Pancreatico-biliary Sciences (ILGPS) at Sir Ganga Ram Hospital, successfully removed an unusual but dangerous foreign body – a tablet with intact aluminium blister foil which was stuck in the food pipe (esophagus) in an elderly male; using an innovative endoscopic technique.
According to Prof. Anil Arora (Chairman, ILGPS) a 61-year-old male came to emergency with severe chest discomfort after accidentally swallowing a tablet with intact aluminium blister foil cover. This “foreign body” had got stuck in the upper esophagus and hence, he was unable to swallow anything and was repeatedly spitting saliva. An endoscopy was immediately done which revealed a complicated situation.
Dr Shrihari Anikhindi, Consultant Gastroenterologist and Therapeutic Endoscopist at ILGPS elucidated the challenges. He said “The tablet-intact foil was stuck in the narrowest portion of upper esophagus which did not allow any room for endoscopic manoeuvring and removal. (Figure 1) The aluminium foil was very rigid and had sharp edges. Hence, any forceful removal could have easily injured the esophagus leading to devastating complications like perforation, bleeding, mediastinal infection and sepsis which would have required an emergency surgery with its attendant complications.”
But as they say challenges breed ingenuity, the ILGPS team devised a way to circumvent the aforementioned challenges. “Since direct removal from the site of impaction (esophagus) was dangerous, we gently and slowly pushed the tablet with intact foil into the stomach. This give us ample room for manoeuvring special accessories, said Dr Shrihari Anikhindi. Once it was inside the stomach (Figure 2), we punctured the aluminium foil using a special endoscopic needle and pushed saline under pressure.
This dissolved the inner tablet (Figure 3) and all the contents came out of the foil in stomach cavity (Figure 4). As the foil contents were now emptied, it was possible for us to fold the aluminium foil onto itself. This reduced the diameter and inverted the dangerous sharp edges. Using a special accessory called endoscopic mucosal resection (EMR) cap attached to endoscope, we were able to safely remove the folded aluminium foil out through the mouth (Figure 5). Confronting a difficult and precarious situation, we were glad to perform a safe and quick removal of foreign body using a safe innovative technique.
Prof Anil Arora said, “Surprisingly, this is the 2nd time we are encountering such a case and have been successful using this approach on both occasions. Such cases have not been reported in literature. Since there is no standardised approach to such rare impacted foreign bodies, we had to be think out of the box. We had to remove a dangerous impacted foreign body while ensuring the safety of internal lining of the esophagus, stomach and throat. At Sir Ganga Ram Hospital, we have a well-trained, highly skilled team which is well equipped to deftly tackle such difficult situations.
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