Foreign body ingestions in the pediatric population and techniques of endoscopic removal

Foreign body ingestions are common in pediatric patients and represent a challenge for the pediatric endoscopist. The most common objects ingested by children in the United States are coins, although toys and batteries account for a significant fraction of ingestions. The timing of and requirement for endoscopy is based on the type of foreign body ingested, its location, and the presence or absence of symptoms. In some cases, ingested foreign bodies require urgent removal even in asymptomatic patients. This is the case, for example, with esophageal batteries. In smaller pediatric patients, the size of the foreign body is an important factor in determining the timing and requirement for endoscopy, and the management may differ as compared with adults. Areas of anatomic narrowing or disease may be an underlying reason why a foreign body becomes lodged, and endoscopists are cautioned against blindly advancing a foreign body or meat impaction distally. Various techniques and endoscopic equipment are used to remove ingested foreign bodies in children, including specialized forceps, baskets, snares, nets, and friction fit adapters, and these are discussed.