Safe endoscopic removal of a sharp-edged foreign body from a dog's stomach
Although this gastric foreign body was an incidental finding, it was just a matter of time before if caused gastrointestinal distress. Inserting an endoscope through a protective overtube allowed the sharp object to be retrieved without inflicting further damage.
3. For removal of the foreign body, the endoscope was passed through the lumen of a protective overtube (a modified equine
stomach tube).
Direct removal of the foreign body with an endoscopic snare or basket forceps was not opted for because the foreign body's
sharp edges could potentially have damaged the lower esophageal sphincter or esophagus. Therefore, a large-diameter, close-ended
equine stomach tube was modified so that it could be used as a guard or overtube into which the foreign body could be retracted
once it was grasped by an endoscopic snare (Figure 3). The stomach tube was cut so that it extended from just beyond the nose to about 10 cm caudal to the last rib and was marked
at the length that was needed to enter the stomach. Before oral intubation, the insertion end (cut end of tube) was flamed
with a butane lighter to remove any sharp edges. The stomach tube was well-lubricated and slowly advanced into the esophagus.
It was somewhat difficult to advance the tube through the lower esophageal sphincter, but, with gentle manipulation, it passed
into the stomach. The endoscope was then passed through the tube into the stomach. Since the endoscope did not completely
fill the tube's lumen, air quickly leaked out of the stomach. This made it difficult to adequately distend the stomach, and
continuous insufflation was necessary throughout the removal procedure.
4. Relative positions of (left to right) the endoscopic snare with its clear sheath, endoscope, and protective overtube within
the gastric lumen.
An endoscopic snare was advanced through the biopsy channel of the endoscope and into the gastric lumen 2 to 4 cm beyond the
tip of the endoscope. The snare was extended from its protective sheath and manipulated so that it encircled the foreign body.
The snare was then retracted into the sheath until the foreign body was tightly ensnared and pulled securely up against the
sheath (Figure 4). To prevent the foreign body from damaging the distal tip of the endoscope, the snare was not retracted into the biopsy
channel of the endoscope. Rather, the endoscope and snare were retracted into the overtube until the foreign body was completely
within the tube's lumen (Figure 5). The overtube and endoscope were then simultaneously withdrawn. The foreign body was a triangular piece of glass, about
2.5 cm long, with sharp edges (Figure 6).
5. The foreign body was grasped by an endoscopic snare and retracted into the protective overtube to prevent damage to the
lower esophageal sphincter and esophagus. To prevent the foreign body from damaging the tip of the endoscope, the endoscopic
snare was not retracted into the endoscope.
After removal of the foreign body, the endoscope was again advanced into the esophagus and stomach. There were no gross lesions
in either structure other than the gastric lesions previously noted on initial insertion of the endoscope. Lesions associated
with insertion of the overtube were not observed. The stomach was deflated, and the endoscope was removed.
6. The glass foreign body removed from the patient's stomach. The owners were never able to identify where the foreign body
came from.
After endoscopy and foreign body removal, the patient made an uneventful recovery. Treatment with cimetidine and sucralfate
was continued until the patient was discharged two days later. Follow-up care for the patient's neurologic problems was provided
by the referring veterinarian.
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