Esophageal foreign body removal with foley catheter

Background

  • 85-100% success rates
  • 0-2% complication rates
  • Ideal for coins
  • No reports of airway compromise

Indications

  • Recently 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

References