Endoscopic extraction of large foreign bodies utilizing a novel push-pull extraction technique

Background and Aims: While endoscopic removal of large (2-2.5 cm) objects can be accomplished utilizing a combination of endoscopic accessories, very large (>2.5 cm) foreign bodies are often referred for surgical management. We developed a novel, safe, and effective technique for the removal of very large solid foreign bodies utilizing commercially available endoscopes, dilation balloons, and accessories. Methods: Three consecutive patients who presented with acute foreign body ingestion of very large objects (>2.5 cm × >2.5 cm) underwent a novel push-pull extraction technique employing endotracheal intubation, paralysis, esophageal dilation, and extraction with a double-channel therapeutic endoscope with a combination of balloon-assisted traction (push) and snare guidance (pull). One patient presented after ingestion of a C-type battery (50 mm × 26.2 mm) retained in the gastric antrum. Two patients presented after the ingestion of bundled illicit narcotic packets (46 mm × 43 mm and 36 mm × 26 mm), impacted in the esophagus and the antrum, respectively. Results: Successful endoscopic removal of the very large foreign bodies was safely achieved in all cases (3/3) without surgical assistance. Patients recovered without any reported adverse events and were discharged within 1 hour of the procedure. The procedure times and recovery times were not outside that expected for complex foreign body retrievals. There was no disruption of the plastic packages containing illicit narcotics in the 2 patients who ingested these objects. Conclusions: Endoscopic extraction of very large (>25 mm × >25 mm) foreign bodies is safe and possible utilizing a novel push-pull technique with currently available endoscopes and accessories.