DISCUSSION
Flexible endoscopy is the initial procedure of choice for removing most types of gastric foreign bodies.1
Benefits of this approach include that endoscopic removal can be less invasive and less expensive than a gastrotomy. However,
not all gastric foreign bodies are amenable to endoscopic removal.
Criteria that need to be evaluated before endoscopic removal of a foreign body is attempted include the size, shape, sharpness,
and makeup or consistency of the foreign body.1,2 In addition, the skill and experience of the endoscopist should be considered.1,2 If a practitioner feels that removal of a foreign body in a particular case may be beyond the extent of his or her endoscopic
skills, referral to a facility where endoscopy is more commonly practiced is indicated. Availability of proper instrumentation
to manage each case is another factor that must be considered before attempting foreign body removal. For example, endoscopic
removal of a hard, smooth, spherical foreign body (e.g. a marble) is unlikely to be successful if a basket snare is not available.2
As demonstrated by this case, another relative contraindication to endoscopic removal of a gastric foreign body is if the
object has sharp edges that could potentially damage the lower esophageal sphincter or esophagus when it is removed from the
stomach. In patients with sharp-edged esophageal foreign bodies (e.g. fishhooks), endoscopic removal by using a protective cannula is the treatment of choice.1-3 In this procedure, the endoscope is passed through a cannula or overtube into the esophagus, and the foreign body is grasped
and retracted into the protective cannula or overtube, allowing for safe removal (Figure 5).1-3 This case report demonstrates how the same procedure can be used to safely remove a sharp-edged foreign body from the stomach.
John W. Tyler, DVM, DACVIM
College of Veterinary Medicine
Western University of Health Sciences
Pomona, CA 91766
REFERENCES
1. Tams TR. Endoscopic removal of gastrointestinal foreign bodies. In: Tams TR, ed. Small animal endoscopy. 2nd ed. St. Louis, Mo.: Mosby, 1999;247-295.
2. Guilford WG. Upper gastrointestinal endoscopy. Vet Clin North Am Small Anim Pract 1990;20(5):1209-1227.
3. Gualtiere M. Esophagoscopy. Vet Clin North Am Small Anim Pract 2001;31(4):605-630.
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