Foreign body in the esophagus. (Esophagoscopy Clinic).

A 17-year-old boy came to the clinic with dysphagia that had been caused by an accidental ingestion of a guitar pick the day before. Transnasal esophagoscopy (TNE) detected the foreign body near the lower esophageal sphincter (figure). The scope was easily passed distally to rule out the presence of a stricture or other obstructing lesion in the esophagus and gastric antrum. Then the pick was gently pushed into the stomach. Upon withdrawal of the scope, the esophageal mucosa was carefully inspected at the site of impaction.

Esophageal foreign bodies have traditionally been managed with rigid instrumentation following endotracheal intubation under general anesthesia. Removal of a foreign body via the proximal aerodigestive tract in an awake, nonintubated patient is generally not advisable. However, in carefully selected patients with intact airwayprotective reflexes, TNE can be performed to examine the esophagus adjacent to the foreign body as well as the distal esophagus and antrum. The foreign body can be gently pushed into the stomach if the distal patency of the esophagus can be verified, if there is no suggestion that the esophageal wall has been penetrated (which may occur with many longstanding foreign bodies), and if features of the foreign body do not pose a hazard to the distal gastrointestinal tract.

From the Center for Voice Disorder, Department of Otolaryngology, Wake Forest University Medical Center, Winston-Salem, N.C.; www.thevoicecenter.org