Digestive endoscopic removal of cocaine pellets: evaluation of the safety

Background and study aims: The removal of cocaine pellets by endoscopy is the subject of much debate, due to the supposed risk of rupture. This study aims to evaluate the safety of digestive endoscopic removal of cocaine pellets . Patients and methods: This is a monocentric, observational, retrospective study conducted at the Cayenne Hospital in French Guiana from July 2015 to May 2023. We included patients in whom digestive endoscopy was performed for delayed evacuation despite conservative treatment defined by the persistence of pellets on imaging from the 3rd day of hospitalization. Endoscopy was performed only if presence of pellets at low risk of rupture (type 4 according to the classification by Pidoto in 2002). We collected demographic, imaging, endoscopic and follow-up data. Results: We included 111 patients, 75% were male. The median age was 25 [20-33] years. Imaging was performed in 99% of cases. On the imagery prior to endoscopy, pellets were found mainly in the stomach (28%), right colon (28%), left colon (30%) and sigmoid (31%). Median time to endoscopy was 3 days [2.5-4].The median number of pellets extracted endoscopically was 1 [1-4]. The material used was mainly endoscopic baskets (60%). No patient presented any per or post-endoscopic complications. No pellet ruptured during extraction. There was no sign of cocaine intoxication during or after endoscopy. The success rate of pellet removal was 92% during the first endoscopy and 100% during the 2nd endoscopy. Conclusions: Endoscopic removal of micro-industrially-produced cocaine pellets seems to be safe and effective method. Endoscopy therefore has a place in the management of these patients.

Publication History

Received: 08 April 2024

Accepted after revision: 13 December 2024

Accepted Manuscript online:
23 December 2024