Indications for therapeutic endoscopy for foreign bodies

Methods of managing patients with foreign bodies.

Expectant management: sharp objects (pins, needles, nails, and toothpicks) pass through the gastrointestinal tract without complications in 70-90% of cases within a few days. There are two factors that allow foreign bodies to pass safely through the gastrointestinal tract:

1. foreign bodies usually pass along the central axis of the intestinal lumen;
2. reflex relaxation of the intestinal wall muscles and slowing of intestinal peristalsis leads to sharp objects in the intestinal lumen turning in such a way that they move forward with the blunt end. It is necessary to monitor the patient in a hospital setting with X-ray control of the movement of the foreign body.

Conservative therapy: patients are given buckwheat porridge, a food that is difficult to digest.

Surgical treatment is performed in the presence of signs of perforation of the esophagus, stomach or duodenum with corresponding complications.

Endoscopic treatment of patients with foreign bodies in the upper gastrointestinal tract.

In 1881, Mikulicz was the first to push a foreign body from the esophagus into the stomach. In 1907, Exler described the "needle reflex." This is a protective reflex. When pressing on the mucous membrane with a thin, sharp end of a foreign body, the wall of the organ does not resist, but forms a bay-like depression, the foreign body enters this cavity and does not pierce the wall, peristalsis turns the foreign body blunt end down, and the foreign body moves along the digestive tract. Jackson was the first to extract a foreign body from the stomach using Schindler's apparatus.

Indications for therapeutic endoscopy in case of foreign bodies.

1. Foreign bodies that are loose in the esophagus, stomach and duodenum, small in size, with sharp ends and edges (needles, pieces of glass, nails, halves of razor blades), since these objects can shift deeper and will be difficult to remove.
2. Foreign bodies embedded in the organ wall, taking into account the data of the X-ray examination (whether there are signs of organ wall perforation).
3. Massive foreign bodies with blunt ends and edges, if the size of these objects allows.
4. Foreign bodies of small size with blunt ends and edges or soft consistency, located in the stomach or esophagus for a long time, for example, a coin.
5. Bezoar, if attempts to wash or dissolve it have failed.
6. Left drains after the period of their rejection has expired or in case of complications.
7. Obstruction of the esophagus due to poorly chewed food.

Contraindications to therapeutic endoscopy.

1. The presence of complications requiring surgical treatment.
2. The patient's general condition is severe.

Before fibroendoscopy of foreign bodies, a clinical examination and fluoroscopy or radiography (non-contrast) are performed to clarify the number of foreign bodies and their location. Most foreign bodies move forward, so fibroendoscopy should be done as quickly as possible. The urgency of removing a foreign body depends on its nature, for example, in the case of foreign bodies with sharp edges and edges, an attempt to remove the foreign body should be made immediately, since the needle is often fixed along the lesser curvature due to the nature of peristalsis (for better examination, the patient's body position can be changed). If attempts are unsuccessful, a break is taken for 6-8 hours (all food from the stomach moves to the distal sections) and the examination is repeated, and in the case of large foreign bodies, there is no need to rush - the examination is carried out after 6-8 hours.

Anesthesia and premedication depend on the nature of the foreign body and the mental state of the patient. Most often, the procedure is performed under local anesthesia. In the case of fairly large foreign bodies, obstruction of the esophagus by poorly chewed food, as well as in children, easily excitable patients and the mentally ill, esophagoscopy is performed under general anesthesia with the introduction of muscle relaxants and tracheal intubation. Complete relaxation of the skeletal muscles, as well as the striated muscles of the pharynx and the upper third of the esophagus, facilitates the removal of foreign bodies and minimizes the risk of perforation. Foreign bodies with sharp edges should also be removed under anesthesia.

Instruments used to remove foreign bodies.

1. Polypectomy loop. The main instrument. Loops are soft and hard. A hard loop is better for removing foreign bodies.
2. Grips. Rarely used because they are not very powerful.
3. Magnets. Japanese magnets made from magnetized steel are weak. They make their own magnets from vanadium, but they are more expensive than gold.
4. Rigid, powerful domestically produced instruments for cutting bones. For example, a knife on a bar.
5. Polyvinyl chloride tube for safe extraction of foreign bodies with sharp edges and faces (needles, pins, razors). After the foreign body is captured, the tube, put on the device, is moved so that the foreign body is inside it, after which the device is removed.
6. Catheters and medical glue. Glue can be applied to the cutting surface of the catheter, making it blunt, and then the foreign body can be removed. Glue can be used to remove fragile foreign bodies (e.g., a thermometer). Glue is applied to the area of the foreign body, and then a loop is thrown over this area.
7. Devices for intubation, tracheostomy and artificial ventilation.

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