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endoscope and object withdrawn into the overtube before removal.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.