Endoscopy and endoscopic ultrasound for embedded or migratory digestive foreign body.

Abstract

Embedded or migratory ingested foreign bodies (FBs) may be a disaster when not found intraluminally and can be seriously life-threatening. Endoscopic ultrasound (EUS) has advantages of transmural, close range and real-time imaging. Under its guidance, minimally invasive endoscopic removal of FBs and abscess drainage become available and safe to avoid unnecessary surgery. However, relatively few diagnostic applications of EUS have been reported. Endoscopic removal and abscess drainage with or without EUS-guidance were even scarce. We found 21 cases of migratory FBs reported in which EUS was used to diagnose and/or treat including our case. We further summarized clinical characteristics and EUS manifestations of embedded or migratory FBs for future differentiation, and treatment strategies by endoscopy and EUS. EUS is a valuable tool in recognizing and differentiating embedded or migratory FBs. EUS-guided endoscopic removal is a minimally invasive, safe and innovative solution. EUS with novel device also assists in sufficient and secure drainage for FBs related abscess collections. A multidisciplinary team consult is sometimes mandatory for complicated cases. This would break a conceptual barrier in therapeutic endoscopy.