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Case Report

Journal of International Medical Research

Removal of giant spherical foreign

48(8) 1–5
!Author's 2020 Guide

body in esophagus with endoscope

article reuse:
sagepub.com/journals-permissions DOI:
10.1177/0300060520941332

double forceps and double balloon journals.sagepub.com/home/imr

Shan Yu*, Xiaoming Wang* and Xin Chen

Abstract
In patients with esophageal foreign bodies such as round or similar shaped objects, clamps or traps can
easily fall out as the esophagus narrows physiologically during endoscope removal of the foreign body.
In this case, a double-forceps-channel endoscope and double-balloon were used to remove the large
round foreign body from the esophagus.

Keywords
Foreign bodies, endoscopes, forceps, double balloons, guidewires, esophagus

Date received: 3 February 2020; received: June 19, 2020

introduction Various instruments and methods, endoscopic

double forceps and double balloons are used
The presence of a foreign body in the upper
for successful complete foreign body removal.
digestive tract is one of the most common
this case
disorders of the digestive system. The types of
foreign bodies in the digestive tract are very
complex, and giant spherical foreign bodies are
Department of Gastroenterology, Panzhihua Central
rare. With
Hospital, Panzhihua, Sichuan Province, China
With the development of gastrointestinal
endoscopy, endoscopy has become the first choice *These authors contributed equally to this work.

of treatment for the upper gastrointestinal tract. Corresponding author:

Here we report a case of a giant spherical foreign
body that has become lodged in the upper
esophageal segment. After trying
Xiaoming Wang, Department of Gastroenterology,
Panzhihua Central Hospital, Yikang Road No. 34,
Panzhihua, Sichuan Province 617067, China. Email:
714262144@qq.com

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2 Journal of International Medical Research
The report describes a new method for removing giant
spherical foreign bodies, and we hope it will help
clinicians who encounter this situation in clinical practice.
Case report
A 38 year old man was admitted to the hospital
after swallowing a wax pill incorrectly 2 hours
earlier. Two hours before hospital admission,
after the patient had taken the wax pills, he had
odynophagia and dysphagia but no
hematemesis, fever or other symptoms. As a
result, he came to our hospital. The patient has a
medical history of smoking and drinking, but he
has none
hypertension, heart disease, or a family history of
tumors. His vital signs on admission were stable.
His heart and lungs showed no special
abnormalities. The abdomen is soft, and there is
no tenderness, tenderness, or mass visible on
palpation. Normal bowel sounds. Painless
gastroscopy in our hospital revealed a round
white foreign body confined to the upper end of
the esophagus (Figure 1); the object is firmly
attached to the wall of the esophagus and cannot
be expelled. Endoscopic foreign body extraction
below
Figure 1. A round white foreign body
imprisoned at the upper end of the esophagus.
Intravenous anesthesia is performed in an
emergency.
A transparent cap is placed over the front end
of the gastroscope (model GIF-Q260J; Olympus,
Tokyo, Japan), which is then inserted into the
esophagus. The white round foreign body is
located at the upper end of the esophagus. The
foreign body cannot be cut because it is large and
delicate, and the foreign body forceps are too
small and weak to cut the foreign body (Fig. 2(a)).
We then tried switching to traps (MTN-PFS-
E-24/23; Micro-Tech, Nanjing, China), which also
failed
removing the foreign body because the surface of
the foreign body is very smooth (Fig. 2(b)). Next,
we tried trapping the foreign body with a rock-
catching basket (model FG-23Q-1; Olympus),
which also failed after repeated attempts (Fig.
2(c)). Because the foreign body was large and
tightly lodged in the esophagus, the stone catcher
basket (model B-V232P-A; Olympus) could not be
advanced to the distal end of the foreign body
(Fig. 2(d)). We implanted a macular guide wire
(model M00556580; Boston Scientific,
Marlborough, MA, USA) under the pill along the
clamp canal of the gastroscope. A rock-capturing
balloon is instilled into the distal end of the pill,
which has a diameter of 2.0 cm, but forceful
withdrawal of the balloon cannot be achieved.
move the pill (Fig. 2(e),(f)). We believe that the pill
was strapped too tightly and the pressure on the
balloon and pill was uneven, leading to a sideways
deviation. Therefore, we replaced the double
clamp endoscope (model GIF-2TQ260M;
Olympus) with two macular guide wires, and two
stone-catching balloons implanted at the distal
end of the pill. The two balloons are injected into
space, which has a diameter of 1.5 cm. The two
balloons were simultaneously dragged to the
mouth, and the foreign body was then completely
removed with a rock-net basket (Figure 3).
Endoscope
Yu et al. 3

Figure 2. (a) Failed removal of foreign body with forceps. (b) Removal of foreign body by failed trap. (c) Failed removal of
foreign body with a rock catcher balloon. (d) The stone catcher balloon cannot be inserted into the distal end of the
foreign body. (e,f) The guide wire is used to direct the balloon to the distal end of the foreign body, but the guide wire
cannot withdraw the foreign body.

examination of the site where the foreign body
was inserted reveals congestion and edema of
the mucous membranes; however, no damage,
bleeding, or perforation was observed (Fig. 4).
Written informed consent was obtained from the
patient. This article is a case report, and all details are
anonymous. We have de-identified the details in such
a way that the identity of the patient cannot be
confirmed in any way. The requirement for ethics
approval is waived because this is a case report, and
all details are anonymous.
Discussion
The presence of a foreign body in the upper
digestive tract is one of the most common
disorders of the digestive system. If the foreign
body is trapped, the upper gastrointestinal
mucosa can tear, bleed, or even perforate; This
can lead to a mediastinal abscess,
esophageal aortic aneurysm, or similar
conditions, may even result in death.1
According to the patient's medical history, the
doctor should first check the type, size, shape,
number, and position of the foreign body and the
length of time it has been held, and then select
the most reasonable treatment method. With the
development of gastrointestinal endoscopy,
endoscopy has become the first choice of
treatment for the upper gastrointestinal tract.
Removal of foreign body under endoscope should
be done as early as possible. Under endoscopy,
smooth, spherical, and round foreign bodies
should be removed with a trielcon, basket, foreign
body pliers, or mesh pocket. The types and forms
of foreign bodies encountered in clinical practice
are complex. Foreign bodies with regular edges,
such as circular or circular foreign bodies, have
been reported to be removed with a Foley
catheter.2Foley catheters must be properly
manipulated to be successful
4 Journal of International Medical Research

Figure 3. (a–d) Two guide wires were implanted into the double rock catcher balloon, and the foreign body
was dragged into the mouth.

Figure 4. (a) The white round foreign body was completely removed. (b) The site where the foreign body was
inserted shows congestion and edema of the mucous membranes.

remove foreign objects. If the Foley catheter is occurs during injection of airbag gas, causing
not manipulated properly, a foreign body can be treatment to fail. This operation is also difficult
inserted down the side to perform when a spherical foreign object is
esophagus; Eccentric expansion is also possible completely in the way
Yu et al.
esophagus, resulting in no space in the lumen
of the esophagus; in such cases, the balloon tip
of the Foley catheter is unable to pass through
the foreign body. In patients with spherical or
similar foreign bodies, the clamps or traps can
easily be released when the esophagus
narrows physiologically during endoscope
removal of the foreign body. In this case, a
double-forceps-channel endoscope and double
balloon were used to remove the large round
foreign body from the esophagus.
Thank You
We thank the staff members at Panzhihua Central
Hospital for their support.
Author contributions
Shan Yu, Xiaoming Wang, and Xin Chen treated the
patient. Shan Yu and Xiaoming Wang wrote the
article.
5
Conflict of interest statement
The authors declare that there is no conflict of
interest.
Funding
This research did not receive a specific grant from
any funding agency in the public, commercial, or
not-for-profit sectors.
ORCIDID
Xiaoming Wang https://orcid.org/0000-0003-
1849-2069
Reference
1. Ikenberry SO, Jue TL, Anderson MA, et al.
Handling ingested foreign bodies and food
impaction.Endosc Gastrointest 2011; 73: 1085–
1091.
2. Burgos A, Rabágo L and Triana P. Western views
on the management of gastroesophageal foreign
bodies. World J Gastrointest Endosc 2016; 8:378–
384.