Successful endoscopic extraction of a proximal esophageal foreign body following accurate localization using endoscopic ultrasound: A case report

It is rare to find fish bones completely embedded in the wall of the esophagus with endoscopic findings similar to those of submucosal tumors. Most of the patients had the foreign body removed by thoracotomy or thoracoscopy in the past, which resulted in great trauma.

We report a 58-year-old woman who experienced dysphagia for 6 d after eating fish. Cervical computed tomography (CT) and endoscopic ultrasonography (EUS) indicated a fish bone completely embedded in the wall of the esophagus with endoscopic findings similar to those of submucosal tumors. The results of CT reconstruction and EUS suggested that the fish bone was parallel to the longitudinal axis of the esophagus. We performed a longitudinal mucosal incision from the highest point of the uplift by using an Olympus dual knife to find the fish bone. Unfortunately, no fish bone was found, so we extended the incision and endoscopic submucosal dissection (ESD) technique was used to detect and remove the fish bone entirety.

The extraction of fish bone via ESD immediately after the injection of methylene blue into the submucous membrane under EUS guidance to obtain accurate localization of the foreign body may be the best treatment for such patients.