Endoscopy Video Forum

V4 - Endoscopic Neck Dissection Utilizing Peroral Endoscopic Myotomy (POEM) for Removal of Extraluminal Neck Foreign Body Migrated Out From the Upper Esophagus

Monday, October 8
5:11 PM - 5:18 PM
Location: Terrace Ballroom 1 (level 400)

Category: Endoscopy Video Forum
Sherif Andrawes, MD1, Magda Daoud, MD1, Hafiz Khan, MD1, Petros Benias, MD2
1Staten Island University Hospital, Staten Island, NY; 2Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, NY

Introduction: Foreign body ingestion is a common gastrointestinal emergency, however endoscopic removal of impacted sharp foreign bodies remains technically challenging. Grill brush is comely used and a wire brush bristles are an increasingly recognized as hazard that can present as a foreign body in the aerodigestive tract. Due to their small size and tendency to become embedded in the surrounding tissue, they present a unique operative challenge. Here we present a case of a 50 year old woman who underwent endoscopic extraction of a wire bristle migrated out from esophageal lumen to the space in the neck inbetween the esophagus and trachea wall using peroral endoscopic myotomy ( POEM) technique .

Case description: 50-year-old woman presented to the emergency department with throat pain and odynophagia. The pain started suddenly while eating steak prepared on a grill, and it worsened with swallowing. She described the pain as constant without radiation. Physical examination unremarkable. Lateral neck film showed a thin linear metallic density structure overlying the esophagus at the level of C6-C7. Based on these findings, patient underwent an upper endoscopy in an attempt to retrieve the foreign body. On endoscopy, there was no evidence of the foreign body in the lumen. Using fluoroscopy and endoscopic ultrasound  guidance  the object was identified embedded outside the muscularis propria and an attempt to remove it using forceps through the EUS scope was unsuccessful. It was then decided to proceed with POEM technique for retrieval of the foreign body. The procedure was successful and went uneventfully.

Discussion: Foreign bodies of the upper digestive tract are a common complaint seen by gastroenterologists. Sharp objects, like the wire grill brush bristle described in this case, carry significant risk of complications, which include infection, abscess formation and tracheoesophageal fistulation.  This object was outside the wall of the esophagus and migrated between the esophagus and the trachea, a challenging and critical location for surgical exploration and removal. POEM has potential applications as a rescue technique for retrieval of embedded foreign bodies outside the esophageal lumen within close proximity the muscularis propria. This technique we present here is a byproduct of POEM that was used in this case to remove an extra luminal foreign body avoiding the need for surgical exploration of the esophagus.


Disclosures:
Sherif Andrawes indicated no relevant financial relationships.
Magda Daoud indicated no relevant financial relationships.
Hafiz Khan indicated no relevant financial relationships.
Petros Benias indicated no relevant financial relationships.

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