Novel endoscopic guidewire-assisted transection for removal of an embedded pediatric foreign body: a case report

Pediatric foreign body ingestion is common, but endoscopic removal can be challenging when objects become embedded. We report a novel, nonthermal, guidewire-assisted transection technique to release a metallic carabiner anchored at the pylorus/duodenum by a mucosal bridge. A 13-year-old boy with autism presented 2 weeks after ingestion. Radiographs showed the object unchanged in the stomach over serial imaging. Endoscopy revealed the carabiner fixed at the pylorus, where its spring-loaded gate had closed over a mucosal fold, creating a tissue bridge. A 0.035-inch curved-tip guidewire was looped beneath the bridge and tensioned in a reciprocating motion, mechanically transecting the tissue and freeing the object. A vascular sheath protected the upper gastrointestinal tract during manipulation. The resulting mucosal defect was closed with 5 hemostatic clips, and the patient recovered uneventfully with normal fluoroscopic follow-up imaging. This novel approach avoided surgery and illustrates how device-adapted endoscopic strategies can expand therapeutic options in pediatrics.