Laser-guided rescue: endoscopic removal of complex esophageal foreign bodies

Abstract

Figures

Computed tomography images. a–c A well-defined curvilinear radiopaque density measuring 3.2 × 6.2 cm was noted in the upper thoracic esophagus at the level of the D3 vertebral body with associated short segment circumferential wall thickening (9 mm).

Laser fiber (LightTrail Reusable 365 µm; Boston Scientific, Galway, Ireland) was preloaded onto a catheter (One Action Stent Introduction System [OASIS] internal catheter, 6 Fr, 203 cm; Cook Medical, Bloomington, Indiana, USA).

Case 1. a Laser-guided fragmentation of the denture. b Sectioning of the metallic wire. c Denture after complete fragmentation. d Retrieved denture fragments after removal.

Case 2. a Impacted chicken bone. b, c Laser-guided fragmentation of the bone in the upper esophagus. d Retrieved bone fragment after removal.

Full text

About 10%–20% of esophageal foreign bodies require intervention 1 . Dentures are particularly difficult to remove due to their size, sharp edges, and metal parts 2 . While endoscopy is often effective, some cases need surgery 3 . We report two cases of successful laser-assisted removal of impacted foreign bodies.

Case 1 . A 35-year-old man with alcohol use disorder accidentally swallowed his denture. After failed removal attempts elsewhere, he was referred to our center. Computed tomography (CT) showed a radiopaque object at the D3 level ( Fig. 1 ). Endoscopy confirmed an impacted three-tooth denture with a sharp metallic edge, deeply embedded in the esophageal wall, with a contained perforation. Given the failure of conventional techniques, the patient was intubated and endoscopy-guided laser lithotripsy was used for fragmentation.

Computed tomography images. a–c A well-defined curvilinear radiopaque density measuring 3.2 × 6.2 cm was noted in the upper thoracic esophagus at the level of the D3 vertebral body with associated short segment circumferential wall thickening (9 mm).

Laser fiber (LightTrail Reusable 365 µm; Boston Scientific, Galway, Ireland) was preloaded onto a catheter (One Action Stent Introduction System [OASIS] internal catheter, 6 Fr; Cook Medical, Bloomington, Indiana, USA), compatible with the 2.8-mm channel ( Fig. 2 ). The laser source was a 360-nm Lumenis VersaPulse holmium laser (Boston Scientific, Marlborough, Massachusetts, USA), with settings of 9.6 W, Frequency 8 Hz, Energy 1200 mJ. This allowed precise disintegration. The narrowest section of the denture was cut ( Fig. 3 ), along with the metallic wire and acrylic resin. The entire procedure was completed in 15 minutes without collateral damage. The fragments were extracted with a snare ( Video 1 ). The decubitus ulcer-induced perforation was closed using the loop-and-clip technique.

Laser fiber (LightTrail Reusable 365 µm; Boston Scientific, Galway, Ireland) was preloaded onto a catheter (One Action Stent Introduction System [OASIS] internal catheter, 6 Fr, 203 cm; Cook Medical, Bloomington, Indiana, USA).

Case 1. a Laser-guided fragmentation of the denture. b Sectioning of the metallic wire. c Denture after complete fragmentation. d Retrieved denture fragments after removal.

Laser-assisted endoscopic fragmentation enabled successful removal of impacted esophageal foreign bodies and facilitated endoscopic closure, offering a safe alternative to surgery in complex cases.Video 1

Case 2 . A 67-year-old patient presented with dysphagia after eating chicken. CT revealed a foreign body in the upper esophagus. As in the previous case, retrieval failed. The bone was fragmented using the same laser technique without complications ( Fig. 4 ).

Case 2. a Impacted chicken bone. b, c Laser-guided fragmentation of the bone in the upper esophagus. d Retrieved bone fragment after removal.

Post-procedure assessments showed no leakage. Patients received prophylactic antibiotics, started oral intake the next day, and were discharged after 3 days, without complications.

Laser-assisted fragmentation is a safe and effective alternative for managing complex esophageal foreign bodies 4 5 , reducing surgery and enabling endoscopic closure in cases of perforation.

Endoscopy_UCTN_Code_TTT_1AO_2AL