Work

Laser-guided rescue: endoscopic removal of complex esophageal foreign bodies

Year: 2025

Type: article

Abstract: About 10%–20% of esophageal foreign bodies require intervention [ 1 ]. Dentures are particularly difficult to remove due to their size, sharp edges, and metal parts [ 2 ]. While endoscopy is often effective, some cases need surgery [ 3 ]. We report two cases of successful laser-assisted removal of impacted foreign bodies. Case 1 . A 35-year-old man with alcohol use disorder accidentally swallowed his denture. After failed removal attempts elsewhere, he was referred to our center. Computed tomography (CT) showed a radiopaque object at the D3 level ([ Fig. 1 ]). Endoscopy confirmed an impacted three-tooth denture with a sharp metallic edge, deeply embedded in the esophageal wall, with a contained perforation. Given the failure of conventional techniques, the patient was intubated and endoscopy-guided laser lithotripsy was used for fragmentation. Fig. 1 Computed tomography images. a–c A well-defined curvilinear radiopaque density measuring 3.2 × 6.2 cm was noted in the upper thoracic esophagus at the level of the D3 vertebral body with associated short segment circumferential wall thickening (9 mm). Laser fiber (LightTrail Reusable 365 µm; Boston Scientific, Galway, Ireland) was preloaded onto a catheter (One Action Stent Introduction System [OASIS] internal catheter, 6 Fr; Cook Medical, Bloomington, Indiana, USA), compatible with the 2.8-mm channel ([ Fig. 2 ]). The laser source was a 360-nm Lumenis VersaPulse holmium laser (Boston Scientific, Marlborough, Massachusetts, USA), with settings of 9.6 W, Frequency 8 Hz, Energy 1200 mJ. This allowed precise disintegration. The narrowest section of the denture was cut ([ Fig. 3 ]), along with the metallic wire and acrylic resin. The entire procedure was completed in 15 minutes without collateral damage. The fragments were extracted with a snare ([ Video 1 ]). The decubitus ulcer-induced perforation was closed using the loop-and-clip technique. Fig. 2 Laser fiber (LightTrail Reusable 365 µm; Boston Scientific, Galway, Ireland) was preloaded onto a catheter (One Action Stent Introduction System [OASIS] internal catheter, 6 Fr, 203 cm; Cook Medical, Bloomington, Indiana, USA). Fig. 3 Case 1. a Laser-guided fragmentation of the denture. b Sectioning of the metallic wire. c Denture after complete fragmentation. d Retrieved denture fragments after removal. Download Laser-assisted endoscopic fragmentation enabled successful removal of impacted esophageal foreign bodies and facilitated endoscopic closure, offering a safe alternative to surgery in complex cases.Video 1 Case 2 . A 67-year-old patient presented with dysphagia after eating chicken. CT revealed a foreign body in the upper esophagus. As in the previous case, retrieval failed. The bone was fragmented using the same laser technique without complications ([ Fig. 4 ]). Fig. 4 Case 2. a Impacted chicken bone. b, c Laser-guided fragmentation of the bone in the upper esophagus. d Retrieved bone fragment after removal. Post-procedure assessments showed no leakage. Patients received prophylactic antibiotics, started oral intake the next day, and were discharged after 3 days, without complications. Laser-assisted fragmentation is a safe and effective alternative for managing complex esophageal foreign bodies [ 4 ] [ 5 ], reducing surgery and enabling endoscopic closure in cases of perforation. Endoscopy_UCTN_Code_TTT_1AO_2AL Endoscopy E-Videos https://eref.thieme.de/e-videos E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos . Publication History Article published online: 08 August 2025 © 2025. 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/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Source: Endoscopy

DOI: 10.1055/a-2658-0099