PMC8585761_01
Images of the embedded foreign body in the esophagus, and extraction via endoscopic submucosal dissection in Case 1. (A) A buried foreign body (arrow) in the esophagus was revealed by a computer tomography (CT) scan at the local hospital. (B) A buried foreign body (arrow) in the esophagus was revealed by the CT scan at our hospital. (C) A mucosal protrusion with a small ulcer was observed with endoscopy. (D) A submucosal injection was performed around the mucosal protrusion. (E) Dissection of the mucosa and submucosa. (F) Endoscopic ultrasound imaging showed a fish bone-like linear hyperechoic mass. (G) Entirely exposed foreign body (a fish bone). (H) Removal of the foreign body (a fish bone) by forceps. (I) The wound was closed by using two metal clips. (J) The removed fish bone.
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F1
An esophageal computed tomography (CT) revealed a foreign body buried in the submucosa of the esophagus (Figure 1A) and an endoscopic diagnosis of esophageal ulcer and bile reflux gastritis was made during this second gastroscopy. CT showed a linear, high-density foreign body embedded at the level of the eighth thoracic vertebra, in the wall of the esophagus, edge clear (Figure 1B). Considering the foreign body had migrated into the deeper layer of the esophagus, the patient was arranged for subsequent ESD. A mucosal protrusion with a small ulcer on it was identified in the proximal esophagus (Figure 1C). A fluid mixture, which consisted of glycerol-fructose injection (250 ml) and epinephrine (2 mg), stained with methylene blue, was injected under the mucosal protrusion (Figure 1D). Subsequently, a mucosal incision was made by using a dual knife (KD-650 L; Olympus, Tokyo, Japan) to facilitate entry into the submucosa (Figure 1E). The EUS showed that the foreign body had migrated from the entry point into the muscularis propria layer (Figure 1F). The foreign body was entirely exposed from its proximal to distal edge (Figure 1G), and was removed with Rat Tooth forceps (Olympus) (Figure 1H). Finally, since the muscularis propria layer was cut, clips were deployed to minimize the risk of post-procedural perforation (Figure 1I). The removed fish bone was 2 cm in length (Figure 1J).
PMC8585761_02
Images of the embedded foreign body in the esophagus, and extraction via endoscopic submucosal dissection in Case 2. (A) A buried foreign body (arrow) in the esophagus was revealed by a computer tomography (CT) scan at our hospital. (B) A mucosal protrusion was observed with endoscopy. (C) Intraoperative endoscopic ultrasound imaging showed a linear hyperechoic mass. (D) Mixture fluid was injected around the mucosal protrusion. (E) An incision was made under the mucosal protrusion with a dual knife. (F) Dissection of the mucosa and submucosa. (G) Removal of the foreign body (a fish bone) by forceps. (H) The removed fish bone.
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F2
An enhanced esophageal CT revealed a linear, high-density, foreign body embedded at the entry to the thorax on the left, front position of the esophagus, with a length of 0.75 cm (Figure 2A). A mucosal protrusion was identified during endoscopy (Figure 2B). Intraoperative EUS was performed and the foreign body was detected as a linear hyperechoic mass (Figure 2C). Mixture fluid was injected under the mucosal protrusion (Figure 2D), and a dual knife was applied to make the incision (Figure 2E). The mucosa and submucosa were dissected (Figure 2F). Finally, the foreign body, a 1 cm long fish bone, was successfully removed with Rat Tooth forceps (Olympus) (Figures 2G,H).