Abstract:

Objective

To investigate the therapeutic value and efficacy of performing ESD guided by EUS for the removal of subepithelial fish bones in esophagus.

Methods

A total of 9 patients diagnosed with esophageal foreign body （fish bone） embedded in the submucosa in our emergency department from January 2017 to March 2024 were retrospectively collected. After relevant conventional gastroscopy and endoscopic ultrasonography examinations， it was confirmed that the foreign bodies were embedded below the esophageal mucosa.

Results

Among the 9 patients with submucosally embedded foreign bodies in the esophagus， there were 3 males and 6 females， with the time of embedding ranging from 2 to 72 hours； CT scans showed that the foreign bodies were lodged in the upper segment of the esophagus in 8 cases， and in the lower segment in 1 case； the main clinical manifestations included a clear sensation of foreign body behind the pharynx and sternum， pharyngeal pain， and retrosternal pain； preoperative endoscopic ultrasonography suggested that the foreign bodies were mainly located in the muscularis mucosae layer in 2 cases， submucosal layer in 5 cases， and muscularis propria layer in 2 cases； all 9 patients successfully underwent ESD guided exploration to locate the embedded fish bones in the mucosa and take out， with a median operation time of 22.33 minutes （range 9-45 minutes）. Intraoperatively， the distance of the foreign bodies （fish bones） from the incisors was 16-22 cm in the upper segment （8/9） and 38 cm in the lower segment （1/9）； regarding the depth of embedding， 2 cases were within the mucosal layer （2/9），5 cases within the submucosal layer （5/9）， and 2 cases within the muscularis propria layer （2/9）， with one case extending to outside the oesophageal cavity （1/9）. Before and during the operation， 2 cases were diagnosed with local small perforations （2/9）， and 2 cases had significant bleeding at the local wound site during the procedure （2/9）； the postoperative hospital stay was 3. 67 days （range 2-7 days）； the follow-up period postoperatively ranged from 41.39 to 86 months （mean 9-86 months） without significant discomfort， and the general condition was good.

Conclusion

ESD guided by EUS for the removal of esophageal subepithelial fish bones in esophagus is safe and effective， offering a new minimally invasive approach for such cases with good clinical application and promotion value.

Key words: Endoscopic ultrasonography （EUS）, Endoscopic submucosal dissection （ESD）, Esophageal fish bone foreign body