Clin Endosc.  2019 Sep;52(5):458-463. 10.5946/ce.2019.042.

Cap-Assisted Technique versus Conventional Methods for Esophageal Food Bolus Extraction: A Comparative Study

Affiliations
  • 1Division of Gastroenterology, Department of Internal Medicine, Cairo University, Kasr Alainy Faculty of Medicine, Cairo, Egypt. Mahmoud.wahba@kasralainy.edu.eg
  • 2Cairo University, Kasr Alainy Faculty of Medicine, Tropical Medicine, Cairo, Egypt.
  • 3Department of Internal Medicine, Beni-Suef University, Faculty of Medicine, Benisuef, Egypt.
  • 4Department of Internal Medicine, Al-Azhar University, Faculty of Medicine, Cairo, Egypt.

Abstract

BACKGROUND/AIMS
Food bolus impaction is the most common form of esophageal foreign body impaction observed in adults. Clinical guidelines recommend using the push technique or retrieval methods in such cases. The push technique can cause injuries in certain clinical situations. Notably, conventional retrieval methods are time and effort consuming. Cap-assisted endoscopic extraction of an impacted food bolus is an easy and effective technique; however, more data are needed for its validation. This study compared the capassisted extraction technique with conventional methods.
METHODS
This prospective observational multicenter study compared the success and en bloc removal rates, total procedure time, and adverse events in both techniques..
RESULTS
The study included 303 patients who underwent food bolus extraction. The push technique was used in 87 patients (28.7%) and a retrieval procedure in 216 patients (71.3%). Cap-assisted extraction was performed in 106 patients and retrieval using conventional methods in 110 patients. The cap-assisted technique was associated with a higher rate of en bloc removal (80.2% vs. 15%, p<0.01), shorter procedure time (6.9±3.5 min vs. 15.7±4.1 min, p<0.001), and fewer adverse events (0/106 vs. 9/110, p<0.001).
CONCLUSIONS
Cap-assisted extraction showed no adverse events, higher efficacy, and a shorter procedure time compared with conventional retrieval procedures.

Keyword

Foreign body; Food bolus; Cap-assisted extraction

MeSH Terms

Adult
Foreign Bodies
Humans
Methods*
Prospective Studies

Figure

  • Fig. 1. Image showing food bolus impaction at the distal esophagus. (A) Underlying lesion can be observed preventing the use of the push technique. (B) Esophageal perforation is likely if the pushing action is continued blindly. (C) Cap-assisted extraction serves as an easy method of food bolus extraction.

  • Fig. 2. Image showing the technique of cap-assisted extraction. The cap is applied with a slight twisting movement, and continuous suction is performed with gentle withdrawal of the scope.

  • Fig. 3. Image showing the food bolus is captured within the cap during extraction.

  • Fig. 4. Image showing cap-assisted en bloc food bolus extraction.


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