Endoscopic management of carefully selected asymptomatic body stuffers

The guidelines from the European and American Societies for Gastrointestinal Endoscopy discourage endoscopic retrieval of drug bags in body stuffers. However, recent evidence challenges this stance, demonstrating successful bag retrieval without fatal outcomes. We present two distinct cases illustrating varying outcomes of intervention. The first involves a 30-year-old asymptomatic man who ingested a plastic bag containing 3,4-methylenedioxymethamphetamine (MDMA). Despite initial identification and successful retrieval via upper gastrointestinal (UGI) endoscopy, the second case, a 50-year-old asymptomatic man who ingested a balloon filled with MDMA, alprazolam and lorazepam, required laparoscopic removal due to technical challenges during endoscopy. These cases prompt reconsideration of current guidelines, particularly in light of emerging literature advocating for early UGI endoscopy as a viable intervention. However, proficiency in UGI endoscopy, often necessitating additional experience beyond standard training, remains imperative for successful outcomes in such cases.