The Role of Tunnel Endoscopy in a Hidden Esophageal Foreign Body

Abstract

A 37-year-old woman was referred to our center with a 3-day history of foreign body (FB) sensation after eating fish. Physical examination was unremarkable, and laboratory tests revealed leukocytosis (12.4 3 10 9 /L). Although EGD at the referring center was negative, computed tomography at admission revealed a definite high-density object in the cervical esophagus (a). Under general anesthesia, EGD was performed, showing mucosa erosion at the upper esophagus, but no FB was visible with careful inspection, suspicious of an esophageal FB entirely embedded in the submucosal tissue. Given that the patient's symptoms persisted, after a discussion of the multidisciplinary team, we attempted a submucosal endoscopy examination to explore the hidden FB. After submucosal injection, the mucosa was incised as entry at 17 cm from the incisors, followed by dissection of the submucosal tissue using a DualKnife. During the creation of the tunnel, there was no obvious FB, until a whitish object was noticed in the underlying muscular layer (b). The superficial muscular tissue was dissected, demonstrating a fish bone, which was then removed from the tunnel with a forceps (c). The mucosal entry was closed with 2 clips. With a short period of fasting and hospitalization, the patient was discharged smoothly. (Informed consent was obtained from the patient to publish these images.