George B. Saffouri, MD, and Louis M. Wong Kee Song, MD, FASGE, from the Division of Gastroenterology and Hepatology, Mayo Clinic, in Rochester, Minnesota, USA share this VideoGIE case “Burn and anchor: a novel food impaction retrieval technique.”
Both video cases demonstrate challenging, meaty food impactions with patients unable to manage their secretions. Standard push and extraction techniques were attempted, but these proved to be unsuccessful. After endotracheal intubation for airway protection, we employed a bipolar coagulation probe set at 25 watts to burn a tract into, but not fully through, the center of the food boluses. This required constant contact pressure with the center of the meat bolus to avoid iatrogenic injury to the surrounding mucosa. Next, we deployed a tri-prong anchor device (OTSC Anchor, Ovesco Endoscopy AG, Tubingen, Germany) through the newly-created tract, anchoring the food bolus, and ultimately allowing en bloc extraction via traction pull. There were no adverse events in either case.
Food impactions are a universal problem encountered by gastroenterologists worldwide. Most are managed successfully with standard techniques—eg, snares, nets, wide-pronged retrieval forceps, cap-suction method, push method, among others—however, some tightly impacted meat boluses are refractory to these approaches. In creating our video, we sought to describe a novel extraction technique using instruments not normally employed for food boluses.
We hope that the technique described provides another “tool in the toolbox” for endoscopists who encounter challenging food boluses. Both instances involved hard food boluses, and we suspect this allows for optimal anchoring of the tri-prong device. It is crucial to mention that both cases required endotracheal intubation for airway protection, which we do recommend when employing this technique.
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