Device choice and experience level in endoscopic foreign object retrieval: an in vivo study

Area of Science:

• Gastroenterology
• Medical Devices
• Surgical Techniques

Background:

• Foreign object retrieval in the gastrointestinal tract is a common endoscopic challenge.
• The optimal device and the impact of endoscopist experience remain under-evaluated.

Purpose of the Study:

• To systematically evaluate the efficacy of different endoscopic retrieval devices.
• To assess the influence of endoscopist experience on foreign object retrieval success rates and times.

Main Methods:

• Anesthetized pigs underwent endoscopic placement of foreign objects (tack, button battery, toothpick) in the stomach.
• Seven attending physicians and four fellows used five different retrieval devices (Roth net, rat tooth forceps, Dormia basket, snare, radial jaw forceps).
• Time to retrieve each object within a 5-minute limit was measured.

Main Results:

• Roth net and Dormia basket were effective for button batteries; Roth net was superior (100% vs. 27%).
• All devices were equally successful for tacks (82-100%). The snare was faster and encountered fewer difficulties.
• Roth net failed with toothpicks; other devices were successful (91-100%).
• Experienced clinical attendings had higher success rates (95%) and faster retrieval times compared to fellows and basic science researchers.

Conclusions:

• The Roth net is optimal for smooth objects like button batteries.
• The snare is recommended for sharp objects (tacks, toothpicks), with forceps also being effective.
• Endoscopist experience level is a critical factor in successful foreign object retrieval, influencing both success rates and procedure speed.