Overview

• If the patient has no respiratory distress and can manage his oral secretions, emergency removal of the foreign body may not be necessary.
    

• If the foreign body has smooth surfaces and is nontoxic, delaying extraction may be justified, because most blunt objects will pass spontaneously through the GI tract without incident. 
   

• However, sharp-edged or pointed foreign bodies and disk batteries, which may leak caustic material, should be removed promptly because of their potential for esophageal injury and perforation.  
  
  

• In any case, no foreign body should be allowed to remain in the esophagus for more than 24 hours, as the incidence of complications begins to rise. 
  
  

• The classic approach to management is esophagoscopy with forceps or snare removal of the foreign body.  Endoscopy is the method most widely advocated for removal of sharp objects. 
  
  

• The benefits of endoscopy include:

  • the ability to visualize the foreign body during its capture and removal, 

  • to protect the airway, 

  • to evaluate the esophagus for injury and underlying pathology.  
    
    

• The disadvantages of endoscopy include:

  • its high cost; 

  • the frequent need for general anesthesia, especially in children; 

  • the risk of esophageal perforation when the extraction instrument is passed around the foreign body where the endoscopist cannot visually control its tip.  
    
    

• In experienced hands, endoscopy has a reported success rate of at least 90% and a complication rate of 1-13%.