Korean J Gastroenterol.  2013 Apr;61(4):215-218. 10.4166/kjg.2013.61.4.215.

Salvage Technique for Endoscopic Removal of a Sharp Fish Bone Impacted in the Esophagus Using a Transparent Cap and Detachable Snares

• Lee JS
• Chun HJ
• Lee JM
• Hwang YJ
• Kim SH
• Kim ES
• Jeen YT
• Lee HJ

• KMID: 1775761
• DOI: http://doi.org/10.4166/kjg.2013.61.4.215

Abstract

A sharp, impacted fish bone in the esophagus is an indication for urgent endoscopy. Endoscopic removal of such an object is a challenging task. An endoscopic protector hood is then used to remove the object. However, an endoscopic hood protector is not always available. In a patient with a large hiatal hernia, the protector hood may not return to the original shape when it passes through the gastroesophageal junction and therefore may not properly protect the esophageal mucosa from the sharp foreign body. In our case, it was impossible to deploy the endoscopic hood protector through the gastroesophageal junction despite multiple attempts. We propose an alternative solution for such cases. We safely removed a large sharp-edged flat fish bone that was folded and compressed using a detachable snare after releasing and pushing the fish bone into the stomach using an endoscope equipped with a transparent cap used for dilating the esophageal wall. This method of using an endoscopic cap and detachable snare is a safe, useful alternative for endoscopically removing a large sharp-edged flat foreign body from the upper gastrointestinal tract. This alternative technique has not been reported in the English medical literature.

Keyword

Sharp fish bone; Foreign bodies; Detachable snare; Transparent cap; Endoscopes

MeSH Terms

Aged, 80 and over
Esophagoscopy/*instrumentation/methods
*Esophagus
Foreign Bodies/radiography/*surgery
Humans
Male

Figure

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  Fig. 1. The endoscope revealed that a large sharp-edged flat fish bone impacted just below the upper esophageal sphincter, 25 cm from the incisors.

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  Fig. 2. The fish bone was moved into the stomach.

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  Fig. 3. (A) Detachable snares (Olympus MAJ-340; Olympus Ltd.) were applied over the fish bone. (B) The fish bone, which had a tetragonal shape, was compressed and folded using two detachable snares, thus transforming it into an elongated shape.

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  Fig. 4. There was mild hemorrhage in the upper esophagus, which was where the fish bone was impacted, but there were no serious complications such as perforation.

Reference

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