# Awake Forceps Retrieval of Complex Pharyngeal Fish Bone Impactions Using a Single-Use Nasendoscope With an Instrument Channel: A Retrospective Case Series

## TL;DR

A new method using a single-use scope to remove fish bones from the throat while patients are awake is shown to be safe, effective, and much cheaper than traditional surgery.

## Contribution

Demonstrates the clinical and economic benefits of using a single-use nasendoscope for awake fish bone removal.

## Key findings

- Awake nasendoscopic retrieval succeeded in 80% of cases with no complications.
- The technique saved £3,720 per successful case compared to general anaesthesia removal.
- The method remains cost-neutral with a success rate above 5.2%.

## Abstract

Objective: Pharyngeal fish bone impaction is a common ENT emergency with significant potential morbidity. Most cases are managed perorally, but deeper or complex impactions often require removal under general anaesthesia (GA). Retrieval using forceps through the working channel of a nasendoscope is an established alternative, though uptake has been limited by the decontamination requirements of reusable channelled nasendoscopes. Single-use channelled nasendoscopes may enable wider adoption of this technique, improving care and reducing costs. This study aims to evaluate the clinical effectiveness and economic impact of awake single-use channelled nasendoscope-guided retrieval of pharyngeal fish bones compared with removal under GA.

Methods: A retrospective case series at a tertiary London hospital reviewed adults treated between February and May 2025 for pharyngeal fish bone impaction unsuitable for peroral extraction. Awake retrieval was performed using a single-use channelled nasendoscope and flexible crocodile forceps. Data were analysed for success, complications, GA requirement, and costs using NHS England 2024/25 tariffs and device prices.

Results: A total of 10 patients (median age 53.5 years, range 37 to 80 years; 7:3 female:male) met the inclusion criteria. Nasendoscopic retrieval succeeded in 8/10 cases (80%) with no complications. Two patients required theatre removal under GA. The mean cost per nasendoscopic case was £202 compared with £3,922 for GA removal, saving £3,720 per successful case (94.8% reduction). Cost modelling showed the technique remained cost-neutral above a 5.2% success rate.

Conclusion: Awake single-use channelled nasendoscope-guided removal of pharyngeal fish bones is safe, effective, and substantially cheaper than GA removal. Wider adoption could reduce theatre demand, anaesthetic exposure, and overall healthcare costs.