Endoscopic Management of Foreign Body Ingestion: What You Need to Know

Foreign body ingestion is a commonly encountered medical emergency worldwide. It is more prevalent in the pediatric population, accounting for approximately 80% of cases in children aged 4 to 14 years. However, about 20% of cases are seen in adults, often due to accidental ingestion.

Intentional ingestion is most frequently observed in psychiatric patients, such as those with borderline personality disorder. Patients with Pica disorder may ingest non-food items or blunt objects. In elderly individuals, foreign body impaction is often pathological, caused by malignancies, strictures, or motility disorders.

While most foreign bodies pass spontaneously, around 10% to 20% require emergency endoscopic removal.

Classification of foreign body

Category	Sub-category	Examples / Notes
Radiographic Characteristics	Radiopaque	Appear white or bright on X-ray (block X-rays)
	Radiolucent	Appear dark or invisible on X-ray (allow X-rays to pass through)
Blunt Objects		Button, coin, toy, battery
Sharp Objects	Sharp Pointed Objects	Nail, toothpick, needle, safety pin, fishbone
	Sharp Irregular Objects	Partial denture, razor blade
Long Objects	Soft Objects	String, cord
	Hard Objects	Toothbrush, ball pen, screwdriver, spoon, fork
Food Bolus Impaction	Non Pathological	Bone( Most commonly fish bone)
	Pathological	Malignancy, Stricture, Motility disorders, eosinophilic esophagitis
Narcotic Body Packs		Intentionally ingested by substance abusers or drug carriers
Bezoars	Phytobezoar	Plant fibers
	Trichobezoar	Hair (commonly in psychiatric patients)
	Pharmacobezoar	Undissolved medicines
	Lactobezoar	Undissolved milk proteins

Symptoms

In children, history may not always be available. Warning signs include:

• Sudden refusal to eat

• Drooling

• Respiratory symptoms such as coughing or wheezing (suggesting possible aspiration)

In adults, typical symptoms include:

• Sudden dysphagia while eating

• Odynophagia

• Chest pain

• Inability to handle secretions

Diagnosis is primarily based on clinical history and physical examination.A plain X-ray is the initial imaging modality of choice to locate radiopaque foreign bodies and to assess for complications such as:

• Pneumoperitoneum (air under the diaphragm)

• Pneumomediastinum

• Pleural effusion

·        Management

·        Endoscopy is the gold standard for removing foreign bodies.However, in cases with complications like perforation or obstruction, surgical intervention may be necessary.

Do’s and Don’ts in Foreign Body Ingestion

✅ Do’s:   Seek immediate medical attention for ingestion of sharp or blunt objects.

 Check for airway compromise or respiratory distress.

❌ Don’ts:

1. Do not give banana, milk, or any food orally – it increases the risk of aspiration and hampers endoscopic visibility.

2. Do not perform abdominal thrusts (Heimlich maneuver) – especially with sharp objects, as they may cause perforation.

3. Do not induce vomiting – sharp objects may injure the GI tract during regurgitation.

Case Presentations:

Image 1: Endoscopic image showing a child with an ingested battery. (Image credit: Dr. Naveen Kumar)

Image 2 :Endoscopic removal of the battery using a Snare Roth Net. (Image credit: Dr. Naveen Kumar)

Image 3 : Endoscopic image showing leaked battery causeing ulceration.(Image credit: Dr. Naveen Kumar)

Image 4 : Endoscopic remaval of esophageal battery using Foreign body forceps.(Image credit: Dr. Naveen Kumar)

Image 5 : Endoscopic view of a locket foreign body in child.(Image credit: Dr. Naveen Kumar)

Image 6 : Endoscopic view a coin in stomach ingested 15 days back.(Image credit: Dr. Naveen Kumar)

Image 7 : Radiographic view showing sharp foreign body in stomach (radiopaque white nail).(Image credit: Dr. Naveen Kumar)

Image 8 : Endoscopic removal of nail without any complications.(Image credit: Dr. Naveen Kumar)

Image 9 : Endoscopic view of bone foreig body in esophagus.(Image credit: Dr. Naveen Kumar)

Image 10 : Endoscopic removal of a bone foreign body without complications.(Image credit: Dr. Naveen Kumar)

Conclusion

Foreign body ingestion is a common yet potentially serious medical emergency that requires prompt recognition and appropriate management. While many cases—especially in children—resolve spontaneously, a significant number necessitate endoscopic intervention to prevent complications such as perforation, obstruction, or infection. Accurate diagnosis through clinical evaluation and imaging, coupled with timely endoscopic removal, is crucial for optimal outcomes. Educating caregivers and the general public on the do’s and don’ts following suspected ingestion can help prevent worsening of the condition. With advancements in endoscopic techniques, most foreign bodies can be safely and effectively removed without the need for surgery.

About the Author

Dr. Naveen Kumar, MBBS, MD, DM (Gastroenterology, PGIMER Chandigarh)Director, Department of GastroenterologySri Harihar Hospital and Research Center, Gutkar, District Mandi, Himachal Pradesh.

Dr Naveen Kumar

 Dr. Naveen Kumar is a highly respected gastroenterologist with advanced training from the prestigious PGIMER, Chandigarh. As the Director of the Department of Gastroenterology at Sri Harihar Hospital and Research Center, he brings exceptional expertise in diagnosing and managing a wide spectrum of digestive disorders, with a strong focus on advanced endoscopic techniques.

He is the first and only gastroenterologist in Himachal Pradesh performing endoscopic ultrasound (EUS) and cutting-edge procedures like Peroral Endoscopic Myotomy (POEM) for achalasia cardia, setting new standards in gastrointestinal care across the region.

Renowned for his patient-centered care and commitment to clinical excellence, Dr. Naveen also plays an active role in medical education and public awareness through his writings and academic contributions.

He is the editor of this article, and all endoscopic images included are credited to him.

📧 Email: contact@drnaveenkumargastro.com🐦 Twitter: @drnaveenm