From Bile Ducts to Esophagus: A Novel Cholangioscopic Method for Foreign Body Removal

CASE REPORT Endoscopic esophageal foreign body removal is a challenge in cases of foreign bodies lodged in strictures. We report the use of a conventional cholangioscopic accessory in an unconventional foreign body removal. A 4-year-old girl was a case of esophageal atresia status after gastric pull up and anastomosis with anastomotic site stricture. She had undergone Savary-Gilliard dilatations previously and now presented with acute dysphagia to both solids and liquids after having savories. The child had no signs of alarm and was vitally stable. The child underwent upper gastrointestinal endoscopy. A stricture was visualized just below the upper esophageal sphincter beyond which adult and pediatric gastroscopes could not be passed. Serial dilatation was done using Soehendra biliary dilatation catheter 5-7-10 mm and 5 Fr, 7 Fr, and 9 Fr SG dilators. Pediatric scope could pass after dilating; however, another new stricture with an overlying food bolus was visualized below (Figure 1). Attempts to remove the hard food bolus using pediatric biopsy forceps failed. Size of the food bolus and the working channel of the scope was compared and possible use of cholangioscopy accessory—Boston Scientific SpyGlass (Malborough, MA) retrieval basket was contemplated. The retrieval basket was introduced in the accessory port of the pediatric gastroscope and passed beyond the food bolus capturing it and removed en bloc (Figures 2, 3 and 4). Despite a challenging anatomy, the procedure was uneventful, quick, and sans surgery (Video 1).Figure 1.: Food bolus lodged over the second stricturous narrowing.Figure 2.: SpyGlass used to remove the food bolus.Figure 3.: Stricture site after removal of food bolus.Figure 4.: Stricture site after dilatation. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1","caption":"Esophageal Foreign Body Removal using Cholangioscopy Spyglass Retrieval Basket.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_brz3fshx"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Accessories such as retrieval basket (for removal of stones, foreign bodies such as unretrievable biliary or pancreatic duct stents) have diameter of 1 mm.1,2 Such accessories could be introduced through the accessory channel port in pediatric gastroscopes which are between 1.5 and 2 mm.3 Eccentric usage of cholangioscopy accessories has been attempted for removal of biliary prostheses and migrated endovascular coils.4,5 We hope our pioneering attempt would help endoscopists to tackle such cases with ease. DISCLOSURES Author contributions: AS Iyer: conceived and wrote the manuscript; V. Rawat and S. Lad: chief endoscopist; M. Shah and M. Kumar: reviewed the manuscript; M. Ingle: correspondence and is the article guarantor. Financial disclosure: None to report. Informed consent was obtained for this case report.