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Category: ESOPHAGOSCOPY FOR FOREIGN BODY
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery

It is a mistake to try to force a foreign body into the
stomach with the stomach tube or bougie. Sounding the esophagus with
bougies to determine the level of the obstruction, or to palpate the
nature of the foreign body, is unnecessary and dangerous.
Esophagoscopy should not be done without a previous roentgenographic
and fluoroscopic examination of the chest and esophagus, except for
urgent reasons. The level of the stenosis, and usually the nature of
the foreign body, can thus be decided. Blind instrumentation is
dangerous, and in view of the safety and success of esophagoscopy,
reprehensible.

If for any reason removal should be delayed, bismuth sub-nitrate,
gramme 0.6, should be given dry on the tongue every four hours. It
will adhere to the denuded surfaces. The addition of calomel, gramme
0.003, for a few doses will increase the antiseptic action. Should
swallowing be painful, gramme 0.2 of orthoform or anesthesin will be
helpful. Emetics are inefficient and dangerous. Holding the patient up
by the heels is rarely, if ever, successful if the foreign body is in
the esophagus. In the reported cases the intruder was probably in the
pharynx.

External esophagotomy for the removal of foreign bodies is
unjustifiable until esophagoscopy has failed in the hands of at least
two skillful esophagoscopists. It has been the observation in the
Bronchoscopic Clinic that every foreign body that has gone down
through the mouth into the esophagus can be brought back the same way,
unless it has already perforated the esophageal wall, in which event
it is no longer a case of foreign body in the esophagus. The mortality
of external esophagotomy for foreign bodies is from twenty to
forty-two per cent, while that of esophagoscopy is less than two per
cent, if the foreign body has not already set up a serious
complication before the esophagoscopy. Furthermore, external
esophagotomy can be successful only with objects lodged
in the cervical esophagus and, moreover, it has happened that after
the esophagus has been opened, the foreign body could not be found
because of dislodgement and passage downward during the relaxation of
the general anesthesia. Should this occur during esophagoscopy, the
foreign body can be followed with the esophagoscope, and even if it is
not overtaken and removed, no risk has been incurred.

Esophagoscopy is the one method of removal worthy of serious
consideration. Should it repeatedly fail in the hands of two skillful
endoscopists, which will be very rarely, if ever, then external
operation is to be considered in cervically lodged foreign bodies.





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