Endoscopic foreign body removal

Abstract

Aspiration of a tracheobronchial foreign body (TFB) is a fairly common emergency occurring more frequently in children than adults. In 2001, an estimated 17,537 children aged ≤14 years were treated in emergency departments for choking-related episodes. One hundred and sixty of these children died due to airway obstruction. A missed or delayed diagnosis of a TFB can cause additional respiratory problems including chronic wheezing that may mimic asthma, chronic cough, and recurrent pneumonia. A delay in diagnosis can also result in airway edema and granulation tissue around the TFB creating difficulty in extraction. Bronchoscopy is a safe procedure allowing full inspection of the airway and visualization of the degree of TFB obstruction. Traditionally, the rigid bronchoscope has been the equipment of choice in the extraction of TFB due to a wide variety of instruments and control of the airway. More recent experience and advances in flexible bronchoscopy instruments, however, have shown that TFB can be safely and successfully removed with flexible bronchoscopy. A team approach to the extraction with anticipation of potential problems and solutions is essential for success. Surgical removal is rarely necessary.