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Food bolus/foreign body obstruction of the upper aerodigestive tract
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
Contrast swallow is not recommended due to the theoretical risk of aspiration, and coating of the contrast medium can obstruct endoscopic examination (Khayyat, 2013). On the other hand, it is useful in the investigation of patients with recurrent food bolus obstruction in the outpatient setting.
Oesophageal Diseases
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Shajahan Wahed, S. Michael Griffin
Ingested foreign bodies and food boluses can impact in the oesophagus. Foreign body ingestion is most commonly seen in children but also in patients with psychiatric conditions. Food bolus obstruction can occur in any patient group. It is sometimes associated with an underlying Schatzki ring, peptic stricture or eosinophilic oesophagitis and occasionally is the first presentation of a malignant stricture. Initial investigations include anteroposterior and lateral plain radiographs, although some radiolucent objects will not be identifiable. CT can also be considered. Airway difficulties, absolute dysphagia, ingestion of sharp objects or button batteries, and prolonged impaction are indications for intervention. Rigid oesophagoscopy in experienced hands is appropriate to locate and retrieve impacted objects in the pharynx and cervical oesophagus. Care must be taken to avoid iatrogenic oesophageal perforation. Flexible endoscopy is the investigation of choice and allows for therapeutic intervention. It has a lower risk of perforation compared to rigid oesophagoscopy. Pushing a food bolus distally without having first passed the endoscope beyond the bolus should be avoided as it increases the risk of perforation.
Endoscopy
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Ewen A. Griffiths, Derek Alderson
A variety of techniques can be used to remove foreign bodies endoscopically, including the use of forceps, nets, snares, and tripod-type graspers. Patients who present with food bolus obstruction and no obvious cause should have esophageal biopsies taken either at the time of index endoscopy or at a later date to exclude eosinophilic esophagitis. Food boluses can be removed piecemeal with the use of nets and gentle pushing pressure of smaller pieces into the stomach. After removal of any foreign body, the esophagus should be inspected for underlying disease, perforation, or ischemic injury.
OverStitch Sx Endoscopic suturing system in minimally invasive endoscopic procedures: overview of its safety and efficacy and comparison to oversticthTM
Published in Expert Review of Medical Devices, 2022
Tara Keihanian, Mohamed O Othman
Utilizing endoscopic suturing could be challenging. One challenge that would arise is threading loop behind the needle driver; Bove et al. suggest partial closure of the needle driver while advancing the anchor exchange and retrieving the anchor exchange together with the thread [68]. Other reported adverse events are remarkable for submucosal tear requiring clipping or suturing, superficial mucosal abrasion, oozing from the suture site requiring epinephrine injection, suture breakage, and subsequence wound dehiscence [66]. There is one reported case of a food bolus obstruction secondary to migrated OverStitch suture from a previous esophageal perforation repair [69]. Few unique adverse events were noted mainly during ESG such as delayed liver abscess, pneumothorax, gallbladder perforation, gastric perforation and intraabdominal abscess, pulmonary embolism, and death [66]. It is worth mentioning that proficiency in suturing techniques should be established prior to embarking in performing this procedure. Proficiency could be attained by observing instructional videos followed by performing suturing in ex-vivo animal models until endoscopist gain proficiency. Proctorship for the first few cases is also encouraged to assist with troubleshooting.