S4511 Mechanical Lithotripsy Triumph: Resilient Endoscopic Management for Chicken Bone Impaction, Dodging Thoracic Surgery

Introduction: Foreign body (FB) impaction in adults is most often due to accidental food ingestion but may be influenced by factors such as age, intoxication, psychiatric illness, or illicit drug concealment. While many cases resolve without intervention, 10–20% require endoscopic removal. The esophagus’s natural narrowings make it a common site of impaction, and clinical history with imaging guides urgency and choice of retrieval technique. Standard endoscopic tools such as snares, forceps, nets, and overtubes may be ineffective in more complex cases. We present the novel application of a mechanical lithotriptor, typically used for gallstone fragmentation, in managing a difficult esophageal FB impaction, avoiding surgical intervention. Case Description/Methods: A 62-year-old man with hypertension and benign prostatic hyperplasia presented with acute dysphagia after ingesting roasted chicken. He reported 2 prior self-resolved impactions. He was hemodynamically stable but endorsed retrosternal discomfort. Chest x-ray was unremarkable; neck computed tomography identified a 4 cm chicken bone at the C7–T1 level, lodged in the proximal thoracic esophagus with partial wall penetration but no perforation. Upper endoscopy revealed an impacted food bolus at 18 cm, successfully removed using rat-tooth forceps. A horizontally oriented bone at 20 cm resisted multiple retrieval attempts using forceps, snares, and a Roth net, causing superficial mucosal trauma. A 0.038-inch guidewire was looped around the bone and secured to a mechanical lithotriptor. Under direct visualization, the bone was fragmented and safely extracted endoscopically. Residual debris was cleared or advanced into the stomach. The patient remained nil per os post-procedure, and a gastrografin esophagram confirmed no perforation. Discussion: Management of FB impactions depends on object characteristics, location, and patient factors. When conventional techniques fail, surgical intervention may be considered, increasing the risk of complications like bleeding, infection, and prolonged recovery. This case illustrates that mechanical lithotripsy, although traditionally used for biliary stones, can serve as a safe, minimally invasive option for difficult esophageal FB extraction. Limited literature exists on its use for non-biliary FBs, but emerging cases support its utility. Success relies on close coordination among gastroenterology, radiology, anesthesia, and nursing teams. Innovative approaches like this can optimize outcomes and reduce reliance on surgery in GI emergencies.