Real-Time Video-Assisted Retrieval of Airway Foreign Body in Very Young Pediatric Patients

Abstract

ObjectivesAdvancements in medical endoscopy and techniques of rigid bronchoscopy for foreign body removal have enabled higher diagnostic accuracy, reduced morbidity and precise manipulation. However, in pediatric patients, endoscope-combined forceps may be too big to fit into the small sized airway. Here we present our method of endoscope assisted rigid bronchoscopy in pediatric patients and compare the clinical benefits with conventional naked-eye rigid bronchoscopy.MethodsWe used a 2.7 mm, 0° straight endoscope and small caliber grasping forceps with 3.0 to 4.5 mm sized rigid bronchoscopy for very young (<3 years of age) patients of foreign body aspiration. As an assistant held the rigid bronchoscope in situ, the operator could manipulate the endoscope and forceps bimanually. With endoscopic guidance, the foreign body retrieval was performed carefully. The clinical advantages were compared between our endoscope-assisted method (n=29) and the conventional bronchoscopy method (n=33) in terms of operation time and recovery (hospital stay).ResultsBimanual endoscope-assisted rigid bronchoscopy method was technically feasible and safe. The operation time was less, compared to the conventional technique and the patients recovered more quickly. In all cases, our method completely removed the foreign body without need of a second bronchoscopy procedure.ConclusionBimanual endoscope-assisted retrieval of airway foreign body in very young age pediatric patients was superior to the conventional naked-eye method concerning accurate manipulation and safety.

Proposal for methods of diagnosis of fish bone foreign body in the Esophagus

“…Patients suspected of fish bone impaction usually undergo physical and laryngoscopic examination . Foreign bodies in the oral cavity and laryngopharynx are easily detected and removed it.…”

“…Patients suspected of fish bone impaction usually undergo physical and laryngoscopic examination. 2,8 Foreign bodies in the oral cavity and laryngopharynx are easily detected and removed it. However, it can sometimes be difficult to detect fish bones because they are usually of varying radiodensity and may invade the wall of the digestive tract.…”

Tracheobronchial foreign body removal in infants who had very small airways: A prospective clinical trial

“…[1][2][3][4][5] An early diagnosis and prompt removal of the foreign body is very important for reducing the incidence of complications and mortality. [10][11][12] In addition, optical forceps with an endoscope have also enhanced the convenience and accuracy of the procedure with less morbidity. 6 The bronchoscope is a key procedure for diagnosis and treatment of a foreign body in the airway.…”

“…accuracy of diagnosis and removal of tracheobronchial foreign bodies. [10][11][12] In addition, optical forceps with an endoscope have also enhanced the convenience and accuracy of the procedure with less morbidity. 11 Though optical forceps with an endoscope are very useful in foreign body removal, occasionally the application for infant of less than 12 months is limited.…”

A Case of Bilateral Tension Pneumothorax after the Successful CO2 Laser-assisted Removal of a Bronchial Foreign Body in a Child

“…11 The standard technique for bronchial foreign body removal in children is using a rigid bronchoscope. 12 However, in the absence of a compatible rigid bronchoscope or if the foreign body is located in the peripheral bronchus, a flexible bronchoscope can be used. 13 In rare cases (0.3%-0.4%), foreign body removal via tracheotomy might be necessary.…”