FRAGMENTATION OF A FOREIGN BODY IMPACTED IN THE OESOPHAGUS BY THE HOLMIUM:YAG LASER

Aim:

To fragment a foreign body lodge in the esophagus by the Holmium:YAG Laser.

Methods:

A 78-year-old man was admitted to the Emergency Department complaining about sialorrhea and retrosternal chest pain after swallowing a chicken bone. A CT scan was performed initially and no signs of entire esophagus wall perforation were seen. Under general anesthesia, an upper gastrointestinal endoscopy with CO₂ was performed and an embedded crosswise flat and sharp foreign body was found lodged in the distal esophagus. It couldn't be removed after widening distally the esophageal lumen with a balloon.

Results:

Therefore, the Holmium:YAG Laser (Energy 1.2J, Rate 10 Hz, Power 12 W, Flexiva 200, Boston Scientific, USA) was used to cut the bone into two pieces. This procedure was completed with endoscopic forceps scissors FS-3L-1 (Olympus Medical Systems Corp, Tokyo, Japan) and the two fragments were pulled into an overtube and finally removed. Afterwards, the esophagus was endoscopically reviewed and a 6 mm ulcer and a small but deep orifice was observed at the level of the removed bone so an over-the-scope clip (OTSC) (OTSCs; Ovesco, Tübingen, Germany) was deployed to treat the esophageal perforation. Radiological contrast was administered through the endoscope to confirm the orifice closure. There were no complications registered after the procedure. Three days after, no signs of a leakage were seen in the barium esophagogram. Finally, the patient was discharged asymptomatic after four days of hospitalization.

Conclusions:

Esophageal foreign bodies are a common problem encountered by Endoscopy Units. Most of them are solved without morbidity, but serious complications may appear.

The usage of the Holmium:YAG laser can be an option to fragment large and complex esophageal foreign bodies.