View source for Esophageal foreign body removal with foley catheter

==Background==
[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]
[[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]
[[File:Illu esophagus.jpg|thumb|Esophagus anatomy and nomenclature based on two systems.]]
*85-100% success rates
*0-2% complication rates
*Ideal for coins
*No reports of airway compromise

==Indications==
*Recently [[ingested foreign body|ingested]] (<24-48h), smooth, blunt, radiographically opaque objects
*Button batteries ingested <2h with no endoscopy available

==Contraindications==
*Total esophageal obstruction
**Air-Fluid levels on XR or esophagogram
**Patient unable to handle secretions
*Presence of FB greater than 24-48h (higher risk of pressure necrosis)
*Evidence of esophageal perforation
*Airway distress
*Multiple FB's
*Sharp FB's
*Button battery present >2 hours

==Equipment Needed==
*Airway equipment and suction
*Magill and bayonet forceps
*Foley size 10-16F with 5cc to 10cc balloon
*Topical anesthetics
*Sedation meds
*Pediatric restraint devices

==Procedure==
*Localize FB on XR or Fluoro, if available
*Give sedation as needed (ketamine is ideal in kids)
*Place patient in Trendelenberg, supine, lat decub, or prone
*Check balloon for symmetric inflation
*For a child, advance a 12-16F foley orally with balloon deflated
*Advance tip distal to object (if fluoro is used, inject with contrast to view tip)
*Inflate balloon with 3-5 cc saline
*Stop inflation if patient complains of pain
*Apply gentle traction to bring coin proximally
*Terminate attempt if there is excessive friction
*If the balloon slips past the object, try again with an additional 1-2cc saline in balloon
*Once coin is in mouth grab with forceps or ask patient to expectorate it
*If no FB is removed, obtain another XR to see if the object passed to the stomach or moved.

==Complications==
*Most are due to passage of foley through nose
**Nosebleed
**Displacement of FB to nasopharynx
*Laryngospasm and aspiration
*Failure to remove FB

==Disposition==
*No follow up needed for pediatric patients, if FB successfully removed and patient remains asymptomatic
*Arrange follow up for gastric FB's
*If unsuccessful, refer for immediate endoscopy
*All adults should be referred for endoscopy to rule out esophageal pathology

==See Also==
*[[Esophageal foreign body]]
*[[Foreign bodies]]

==External Links==

===Videos===
{{#widget:YouTube|id=k9cG1T20kl0}}



==References==
<references/>

[[Category:Procedures]]
[[Category:GI]]