Modern endoscopist’s toolbox: Innovations in foreign body removal

Table 1 Classification of types of foreign bodies

Category	Subcategories	Examples
By physical characteristics	Size & shape: Small vs large, rounded vs irregular	Coins, nails, bezoars, rings
	Surface texture: Smooth vs Rough	Marbles (smooth), chicken bones (rough)
	Sharp vs blunt	Needles, razor blades (sharp) vs Coins (blunt)
By composition	Organic vs inorganic	Food boluses (organic), metal objects (inorganic)
	Metallic vs non-metallic	Screws, forks (metallic) vs plastic toys (non-metallic)
	Chemical composition	Batteries (lithium, sodium hydroxide), medications
By risk level	High-risk objects	Batteries, magnets, sharp objects (e.g., Razors)
	Low-risk objects	Coins, plastic objects, small rounded items
By clinical context	Accidental ingestion (common in children)	Coins, marbles, small objects
	Intentional ingestion (psychiatric/drug abuse)	Toothbrushes, screwdrivers
	Medically introduced foreign bodies	Endoscopic capsules, stents, dental materials

Table 2 Uses and limitations of retrieval devices

Retrieval device	Uses	Limitations
Biopsy forceps	Used for small, firm objects (e.g., coins, tablets, small bones)	Limited grip on smooth or large objects; may not be effective for fragile items
Rat tooth forceps	Effective for sharp or irregular objects like needles, nails, and fish bones	Risk of mucosal trauma or perforation; difficult to use on slippery objects
Alligator forceps	Used for gripping irregularly shaped or sharp objects	Not ideal for large or rounded objects
Snare	Commonly used for food boluses, coins, and larger objects; can be used for piecemeal extraction	Risk of slippage with smooth objects; cannot be used for very sharp items without additional protection
Polypectomy snare	Useful for removing blunt objects and food boluses; can also aid in piecemeal retrieval	Risk of mucosal injury; not ideal for sharp objects
Retrieval net (Roth net)	Used for retrieving small blunt objects, batteries, and sharp objects like razor blades with added protection	Can be difficult to maneuver in tight spaces
Magnetic probe	Useful for metallic foreign bodies like screws, nails, and coins	Only effective for magnetic objects
Stone retrieval basket	Used for removing button batteries and larger blunt foreign bodies	Risk of fragmentation; may not be suitable for sharp objects
Transparent cap-fitting device	Helps with food boluses and facilitates object removal by suctioning foreign bodies into the cap	Limited to small and soft objects
Overtube	Protects the airway during retrieval, prevents accidental aspiration, and assists in the safe removal of sharp objects	Requires experience for proper placement; may be challenging in patients with strictures
Single/double balloon enteroscope	Used for retrieving objects lodged in the small intestine (e.g., retained capsules)	Technically complex; requires specialized equipment and training, only available in few hospitals

Table 3 Examples of unusual foreign body retrieval

Type of foreign body	Retrieval device
Wire[27]	Biopsy forcep
Sewing needle[28]	Flexible forceps
Multiple razor blades[29]	Raptor grasping device and overtube
Crack pipe[30]	Snare, forceps and overtube
Metal dinner fork[31]	Double wire-loop snare technique
Food bolus[4,19]	Snare, Transparent cap fitting device
Screws in Cecum[32]	Roth net and snare
Wristwatch[33]	Esophageal overtube
Razor blade[34]	Modified overtube
Prune pit[35]	Snare