A variety of foreign bodies may accidentally or intentionally enter the GI tract. However, about 80-90% of cases pass spontaneously and 10-20% will require non-operative intervention and 1% or less will require surgery. The mortality associated with foreign body ingestion is unknown, but 1,500 people die annually of foreign bodies in the upper GI tract in the United States. Most foreign bodies occur in pediatric population, followed by edentulous adults, prisoners, psychiatric patients, then those with alcoholism. The risk of perforation is higher when sharp or pointed metallic objects, animal bones or toothpicks, are ingested. The obstruction or perforation most often occurs at the areas of acute angulation or physiologic narrowing. The level of the cricopharyngeus muscle and ileocecal valve are the most clinically significant. Other common sites for impaction are the aortic arch and diaphragmatic hiatus. Patients with prior GI tract surgery or congenital gut malformations are at increased risk for obstruction or perforation. Diagnostic methods include history of ingestion, physical examination for perforation or obstruction, biplane radiography, contrast radiography, and in some cases, endoscopy. Any foreign body in the hypopharynx or esophagus should be removed. Sharp and pointed bodies, such as razor blades, should be removed because about 15% will perforate bowel. Obstructing foreign bodies should be removed. Some toxic materials, such as disc battery or colour-coding marbles, should be removed. Any foreign bodies thicker than 2 cm and larger than 5 cm tend to lodge in the stomach and should be removed. A long overtube serves to protect the hypopharynx from the trauma of repeated intubations, the airway from aspiration, and the esophagus during extraction of sharp foreign bodies. Sometimes a foreign body protractor hood can be used. It provides protection to the esophagus and posterior pharynx during removal of a foreign body and also prevents dislodging from the grasp of the instrument. Rat-tooth alligator forceps, various retrieval forceps, polyp grasper, polypectomy snare, and dormier basket can all be used. With impacted meat in the esophagus, patients showing salivation have esophageal obstruction that should be endoscoped within a short period of time to prevent tracheal aspiration. Meat lodged in the esophagus without salivation is not an emergency. The technique of pushing an esophageal bolus into the stomach is principally hazardous. Forceful advancement can result in perforation. Sometimes, simple endoscopic suction of the foreign body using an EVL adapter can remove the impacted soft food bolus successfully. This persimmon seed bolus, lodged in the distal esophagus, is removed easily by polypectomy snare. In this case, endoscopy showed a smooth-surfaced meat bolus impacted in the distal esophagus and prevented passage of food. This meat bolus could be removed by a stone basket. Coins can be removed easily with a foreign body forceps, such as the rat tooth or alligator or a snare. Some stones or marbles are very slippery to grasp using a basket. The condom method is very useful in catching this kind of foreign body. A condom attached at the distal tip of the endoscope can be tented by biopsy forceps through the working channel in order to capture the slippery foreign body. In this case, a game stone is easily captured by a condom attached on the endoscopic tip. Rounded objects greater than 2.5 cm in diameter are less likely to pass the pylorus. This kind of large foreign body could be fragmented into small pieces using a large snare. This bezoar in the stomach could be completely removed after fragmentation using a specially invented large snare. Objects longer than 6 to 10 cm, such as toothbrushes or spoons, will have difficulty passing the duodenal sweep and should be removed endoscopically. After a long overtube insertion, the object can be grasped with a snare or a basket and maneuvered into the overtube. Usually, it is easier to approach the fork or spoon from the handle end and then slide the snare up to the handle to the prongs or spoon head. The prong end of the fork can be pulled into the overtube for safe removal. In this schizophrenic patient, endoscopy shows the distal tip of a toothbrush in the esophagus and the wide head portion in the stomach. Using the snare, the toothbrush could be pushed into the stomach to catch the head portion. However, the toothbrush was too long to rotate in the stomach. Finally, it was removed by catching the handle portion of the toothbrush using a snare and overtube. Sometimes, full understanding of the special foreign body's characteristic may offer clues for better removal. Esophageal stents can migrate into the stomach. This memorial metal stent, composed of a long metallic strand, could be stretched and passed through the long foreman like an introducer tube with a metal tip. This stent was removed successfully using this method. Sharp pointed objects lodged in the esophagus, such as chicken and fish bones, straightened paper clips, toothpicks, needles, and dental bridge work represent a medical emergency due to possible perforation and metastasitis. This fish bone lodged in the distal esophagus could perforate the esophagus. To protect the esophageal lumen, a long overtube would be essential. In this case, alligator forceps caught and extracted the fish bone by pulling it to the overtube. If a safety pin is in the esophagus with open end proximal, it is best managed with a flexible endoscope by pushing the pit in into the stomach and then grasping the hinged end and pulling it out first into the long overtube. Some sharp pointed foreign bodies can be reduced in size. In elderly patients with reduced vision, PTT drug packages could be swallowed with pills accidentally. In this case, the size of the PTT package could be reduced by firmly grasping it using the polypectomy snare, especially sharp pointed angles of the PTT package should be blunted for safe removal. An alternative to using an overtube is to attach a foreign body protector hood at the tip of the endoscope. Wrapping the ball tightly around the endoscope tip, the instrument can be passed in the usual fashion. After grasping the foreign body, withdraw the instrument slowly through the lower esophageal sphincter, LES. The LES will catch the ends of the hood and flip it back into its original shape. In the stomach, some foreign bodies can be removed endoscopically. These dentures were removed easily using a snare basket and a long overtube. While the majority of sharp-pointed objects that enter the stomach will pass through the remaining GI tract without incident, 15-30% will eventually perforate the small bowel. Therefore, the sharp-pointed object that has passed into the stomach or proximal duodenum should be retrieved endoscopically if it can be accomplished safely. This dental instrument, which was accidentally swallowed, passed the pylorus and impacted into the proximal duodenal wall. This sharp instrument could be extracted from the duodenal wall using the snare. However, this long instrument with a blunted heavy head is difficult to handle and pass the pylorus. Other instruments, such as retrieval forceps, may have advantages in catching the head portion for easier removal. Special considerations apply with small disc or button battery ingestion. Liquefaction, necrosis, and perforation can occur rapidly when a disc battery is lodged in the esophagus. The battery should be immediately removed. A stone retrieval basket is most often successful. Batteries which have passed beyond the esophagus need not be retrieved unless the patient's manifest signs or symptoms of injury to the GI tract or a large diameter battery greater than 2 cm in diameter remains in the stomach beyond 48 hours. Internal concealment of narcotics wrapped in plastic or contained in latex condoms, referred to as body packing, is seen here in regions of high drug traffic. This cocaine packet can be removed with a snare very carefully. Rupture and leakage of the contents can be fatal. Generally, no attempt should be made to remove drug packets endoscopically instead of surgery due to the risk of rupture. Anis gases impacted in gastric mucosa should be extracted during the routine endoscopic examination. This could be easily caught by biopsy forceps. Ascaris in the duodenum could be removed endoscopically by snare or stone basket because of the risk of biliary obstruction. Endoscopic removal of foreign bodies is very useful in the GI field when used appropriately. Nearly all foreign bodies can be extracted with a flexible endoscope.

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