A135 DEEPLY EMBEDDED ESOPHAGEAL FISHBONE REMOVED BY ENDOSCOPIC MUCOSAL DISSECTION: CASE REPORT AND LITERATURE REVIEW
Bibliographic record
Abstract
Abstract Background Foreign body ingestion is frequently encountered in gastroenterology clinical practice. While most objects pass spontaneously, sharp objects, most commonly bony fragments in adults, have a tendency to become lodged in the esophagus. The European and American Society of Gastrointestinal Endoscopy both recommend emergent endoscopy for sharp objects or bones impacted in the esophagus. However, there is little guidance regarding management of deeply embedded foreign bodies, that may not be visible intra-luminally or that may have penetrated the submucosa or muscularis propria. Aims In this case report, we describe successful endoscopic retrieval of a deeply embedded fishbone in the distal esophagus. A literature review was also conducted to evaluate the current evidence surrounding the use of endoscopic ultrasound (EUS) and submucosal dissection (ESD) to localize and remove deeply embedded foreign bodies. Methods A literature search on EUS and ESD use in foreign body retrieval was performed via MEDLINE/PubMed (September 2023) using relevant keywords and MeSH terms. Results CASE DESCRIPTION A 50-year-old man presented to hospital with several hours of dysphagia after consuming fish. A fishbone deeply embedded through the submucosa into the muscularis propria was identified on CT scan and EUS. ESD was employed to free the bone and a fully covered metal stent was deployed to close the defect. The patient had no immediate complications and recovered well post-procedure. Our literature search revealed a total of 6 case reports detailing endoscopic management of penetrating foreign bodies. One case used EUS to localize an object which was subsequently removed surgically. The remaining 5 cases all used ESD to remove submucosal objects without any short or long-term complications. Conclusions Clinical history is critical to prompt diagnosis of foreign body ingestion, and it is crucial to be familiar with the radiologic characteristics of the suspected object. Fishbones are frequently encountered and are most commonly radiolucent on plain films. CT scans should be obtained in these patients. Rarely, these objects will be found to be deeply penetrating. There are emerging case reports supporting the use of EUS in the localization of some of these objects, particularly when they cannot be seen intraluminally. Upon review of the literature, there is a paucity of reports describing their removal. This case report adds to the sparse literature demonstrating that ESD has an emerging role in the management of deeply penetrating foreign bodies. Following multidisciplinary discussion and consultation with the appropriate surgical service, ESD may prevent the need for otherwise invasive and potentially morbid surgical intervention. Fishbone embedded in the distal esophagus. Removed by ESD, defect closed with metal stent. Funding Agencies None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.007 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".