Post written by Sugata Narayan Biswas, MD, DM, from the Department of Gastroenterology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India.

We often see patients who accidentally ingest various foreign bodies that get lodged in the esophagus and bear risk of esophageal perforation. Prompt diagnosis and timely removal are the key to successful management.

Endoscopic removal using forceps, snares, biliary baskets, and balloons usually aids in the safe removal of foreign bodies. Often these techniques may fail, especially if the foreign body is large, impacted, and difficult to negotiate through the narrow upper esophageal sphincter. Most of these patients with failed endoscopic removal need surgical management, which carries significant morbidity and mortality risks because of complexity of the anatomy and potential for adverse events.

We describe a novel technique of laser-assisted removal of a foreign body impacted in the upper esophagus as a safe and effective endoscopic modality, thus obviating the need for surgery.

An elderly man presented with dysphagia and chest pain after accidental ingestion of a denture a week earlier. On upper endoscopy, a denture was found snugly fit below the upper esophageal sphincter. Initially, using a forceps, we attempted to grasp the denture base and disimpact the flanges from the esophageal wall.

However, because of a wide denture base and flanges firmly impacted on the esophageal wall, it was difficult to dislodge. Holmium laser-assisted endoscopic removal of the denture was planned and discussed with the patient. The denture base was fragmented using the holmium laser (10 W for 2 J at 5 Hz).

Subsequently, 1 limb of a grasping forceps was inserted in the central hole of the denture base created by laser disintegration, and the denture base was firmly gripped. Thereafter, one of the flanges was disimpacted from the esophageal wall and admitted into an overtube, and the entire denture was carefully extracted.

Laser-assisted removal of foreign bodies from the stomach and colon has been previously reported in the literature. However, in this study, we describe the use of laser-assisted fragmentation as a novel and effective modality in the removal of an impacted esophageal foreign body.

The denture base disintegrated by the holmium laser.

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