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CC BY 4.0 · Endoscopy 2024; 56(S 01): E232-E233
DOI: 10.1055/a-2268-5934
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Removal of an embedded gastric fishbone by traction-assisted endoscopic full-thickness resection

Autoren

  • Shuzhen Chen 

    1   Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China (Ringgold ID: RIN74668)

  • Songsong Ying

    1   Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China (Ringgold ID: RIN74668)

  • Cailian Xian

    1   Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China (Ringgold ID: RIN74668)

  • Yongqiang Li

    1   Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China (Ringgold ID: RIN74668)

  • Wenyan Jiang

    2   Department of Ultrasound, Guangzhou First Peopleʼs Hospital, School of Medicine, South China University of Technology, Guangzhou, China (Ringgold ID: RIN74668)

Guangzhou Traditional Chinese Medicine and Traditional Chinese-Western Medicine Integration Science and Technology Project
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A 65-year-old man was referred to our hospital with a half-year history of upper abdominal pain. Endoscopy showed a submucosal eminence on the anterior wall of the gastric antrum ([Fig. 1] a). Endoscopic ultrasonography (EUS) revealed a hyperechoic lesion in the gastric submucosa ([Fig. 2]). A computed tomography (CT) scan showed a long, high density shadow in the gastric antrum, locally protruding into the serosal cavity ([Fig. 3]). Emergency endoscopy was performed with the patient under general anesthesia and with endotracheal intubation ([Video 1]).

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Fig. 1 Endoscopic images showing: a a submucosal eminence on the anterior wall of the gastric antrum; b partial exposure of the fishbone; c attempts to extract the fishbone using foreign body forceps; d snare traction being employed; e endoscopic full-thickness resection being performed; f closure of the perforation with metal clips.
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Fig. 2 Endoscopic ultrasonography image showing a hyperechoic lesion in the gastric submucosa.
Zoom
Fig. 3 Computed tomography images showing the location and depth of the fishbone (red arrow) on: a transverse plane; b coronal plane.
Removal of an embedded gastric fishbone by traction-assisted endoscopic full-thickness resection.Video 1

The mucosa of the gastric antrum was circumferentially incised, exposing one side of the fishbone ([Fig. 1] b). Attempts to extract it using foreign body forceps were unsuccessful, indicating significant adhesion with the surrounding tissues ([Fig. 1] c). Snare traction was then employed ([Fig. 1] d). Subsequently, we performed traction-assisted endoscopic full-thickness resection (EFTR), revealing that the base of the fishbone was enveloped within the omentum ([Fig. 1] e). After the adhesions had been dissected, a 2.5-cm long fishbone was successfully extracted ([Fig. 4]) and the perforation was immediately closed with several metal clips ([Fig. 1] f). The operative and postoperative periods were uneventful, without any complications.

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Fig. 4 Photograph of the extracted fishbone.

A fishbone invading the intrinsic muscularis and serosa of the gastric wall is rare [1]. Removal is often more challenging when there has been prolonged penetration of the gastric wall, and the risk of complications increases [2] [3]. We performed traction using a snare combined with endoclips to assist in ETFR to successfully remove the fishbone. In this case, laparoscopic and open surgery were avoided.

Endoscopy_UCTN_Code_CCL_1AB_2AF

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Conflict of Interest

The authors declare that they have no conflict of interest.

  • References

  • 1 Chiu YH, Hou SK, Chen SC. et al. Diagnosis and endoscopic management of upper gastrointestinal foreign bodies. Am J Med Sci 2012; 343: 192-195
    CrossrefPubMedSuche in Google Scholar
  • 2 Birk M, Bauerfeind P, Deprez PH. et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 489-496
    Suche in Google Scholar
  • 3 Fan T, Wang CQ, Song YJ. et al. Granulomatous inflammation of greater omentum caused by a migrating fishbone. J Coll Physicians Surg Pak 2022; 32: S124-S126
    CrossrefPubMedSuche in Google Scholar

Correspondence

Wenyan Jiang, MS
Department of Ultrasound, Guangzhou First Peopleʼs Hospital, School of Medicine, South China University of Technology
No.1, Pan Fu Road, Yuexiu District, Guangzhou 510180
China   

Publikationsverlauf

Artikel online veröffentlicht:
08. März 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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  • References

  • 1 Chiu YH, Hou SK, Chen SC. et al. Diagnosis and endoscopic management of upper gastrointestinal foreign bodies. Am J Med Sci 2012; 343: 192-195
    CrossrefPubMedSuche in Google Scholar
  • 2 Birk M, Bauerfeind P, Deprez PH. et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 489-496
    Suche in Google Scholar
  • 3 Fan T, Wang CQ, Song YJ. et al. Granulomatous inflammation of greater omentum caused by a migrating fishbone. J Coll Physicians Surg Pak 2022; 32: S124-S126
    CrossrefPubMedSuche in Google Scholar

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Zoom
Fig. 1 Endoscopic images showing: a a submucosal eminence on the anterior wall of the gastric antrum; b partial exposure of the fishbone; c attempts to extract the fishbone using foreign body forceps; d snare traction being employed; e endoscopic full-thickness resection being performed; f closure of the perforation with metal clips.
Zoom
Fig. 2 Endoscopic ultrasonography image showing a hyperechoic lesion in the gastric submucosa.
Zoom
Fig. 3 Computed tomography images showing the location and depth of the fishbone (red arrow) on: a transverse plane; b coronal plane.
Zoom
Fig. 4 Photograph of the extracted fishbone.