Use of Endoscopic Scissors to Remove a Foreign Body Impacted in the Proximal Esophagus

The majority of ingested foreign bodies are uneventfully expelled through the gastrointestinal tract. However, anatomically narrowed areas in the proximal gastrointestinal tract create sites of increased retention/impaction of ingested foreign bodies. Foreign body impaction in the esophagus poses a medical emergency because of the complications associated with delayed management: esophageal perforation, infection, and fistula formation. Thus, urgent endoscopic intervention to remove sharp esophageal foreign bodies is necessary.

A 45-year-old male presented with a 3-day history of a foreign body in the esophagus. Esophagogastroduodenoscopy identified a horizontally lodged V-shaped fishbone with both lateral edges deeply embedded in the esophageal mucosa. When endoscopic removal using traditional removal accessories failed, endoscopic scissors were used to fracture the spinous process edge of the fishbone, and the fishbone was advanced into the gastric lumen. A makeshift endoscope hood was fashioned from a sterile glove, attached to the distal end of the endoscope, and used to remove the fishbone.

The off-label use of endoscopic scissors to relieve the proximal esophageal obstruction by fracturing the fishbone was integral in achieving successful removal.