Endoscopic management of gastrointestinal foreign bodies in children

Endoscopic removal of foreign bodies (FBs) is an important part of therapeutic endoscopy in children. Children most often ingest coins, pins, keys, round stones or marbles, nails, rings, batteries and toys. Coins were the most common FB in the pediatric series of 139 children, who underwent endoscopic removal in Seoul National University Children's Hospital, Korea. The management of FBs depends on the type (sharp or dull, pointed or blunt, and toxic or nontoxic) and the size, along with the location of FB in the gastrointestinal tract. The endoscopist should decide whether endoscopic intervention is necessary and how urgently it has to be done. Indications for removal of FBs from the gastrointestinal tract in children are 1) All esophageal FBs, 2) Gastric or duodenal FBs if they are sharp or pointed, of more than 4 cm long or 2 cm wide in young infants and children; if containing toxic substances and if blunt objects remaining after 2 week observation in the stomach or 1 week observation in the duodenum. Esophageal FBs should be removed within 24 hours because of the risks of perforation and serious fistula formation. Disk batteries can cause corrosive injury to the esophagus within 4 hours. Coin retrieval can be done using the W-shape FB grasping forceps without an endotracheal general anesthesia. Blunt FBs, such as marbles can be best removed with a stone retrieval basket, which can be made from a condom. Disk batteries cannot be grasped with the FB forceps and snares, but very safely with the powerful magnet attached to the tip of the scope. Overtubes and protective rubber hoods are useful for removing sharp or pointed objects. It is important to test the available grasping accessories on a duplicate of the FB as a "dry run" to determine which accessories will grasp the FB securely.