Foreign bodies in the oesophagus

All manner of foreign bodies have become arrested in the oesophagus such as coins, pins and dentures. Button batteries may be a troublesome problem in children. The commonest impacted material is food (Fig. 50.16). Plain radiographs are the most useful examination. A contrast examination is not usually required and may make endoscopy more difficult.

Food impaction is almost always a sign of underlying patho­logy, most commonly a stricture or carcinoma.

 Beware of button batteries in the oesophagus

Foreign bodies that have become stuck in the oesophagus should be removed by endoscopy. Flexible endoscopy is now the method of choice and the majority of objects can be extracted with suitable grasping forceps, a snare or a basket. If the object may injure the oesophagus on withdrawal an overtube should be used, and the endoscope and object with­drawn into the overtube before removal. Button batteries can be a particular worry as they are difficult to grasp and it is tempting to push them on into the stomach. However, an exhausted battery may rapidly corrode in the GI tract and is best extracted. An impacted food bolus will often break up and pass on if the patient is given fizzy drinks and confined to fluids for a short time. The cause of the impaction can then be investigated. If symptoms are severe or the bolus does not pass on it can be extracted or broken up at endoscopy.