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Foreign Bodies in the Airway: Endoscopic Methods

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Interventions in Pulmonary Medicine

Abstract

Airway foreign body (FB) retrieval is synonymous with the birth of interventional pulmonology and bronchology. Once known to be a condition associated with significant morbidity and mortality, the advent of rigid bronchoscopy and other advanced bronchoscopic techniques has drastically improved outcomes related to FB aspiration. Patients that present with acute FB aspiration (hours/days after event) usually present with minimal signs of airway inflammation, while patients with retained FBs tend to have many associated complications such as severe airway inflammation, granulation tissue, bronchial stenosis, and/or post-obstructive pneumonia. The decision to use rigid and/or flexible bronchoscopy should be guided by the patient’s clinical presentation, FB features, and presence of inflammatory sequelae. The interventional pulmonologist has a multitude of techniques and instruments at his/her disposal to successfully manage the retrieval of FBs. Adequate knowledge and training combined with the ability to treat potential adverse events is required to ensure patient safety and to obtain the best outcome.

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Abbreviations

APC:

Argon plasma coagulation

ARDS:

Acute respiratory distress syndrome

CT:

Computed tomography

ED:

Emergency department

EGCR:

Esophagoglottal closure reflex

FB:

Foreign body

GPA:

Granulomatosis with polyangiitis

LES:

Lower esophageal sphincter

Nd:YAG:

Neodymium-doped yttrium aluminum garnet

NSC:

National Safety Council

PDT:

Photodynamic therapy

PGCR:

Pharyngoglottal closure reflex

UES:

Upper esophageal sphincter

References

  1. Zollner F. Gustav Killian. Arch Otolaryngol. 1965;82(6):656–9.

    Article  CAS  PubMed  Google Scholar 

  2. Clerf LH. Historical aspects of foreign bodies in the air and food passages. South Med J. 1975;68(11):1449–54.

    Article  CAS  PubMed  Google Scholar 

  3. Fidkowski CW, Zheng H, Firth PG. The anesthetic considerations of tracheobronchial foreign bodies in children: a literature review of 12,979 cases. Anesth Analg. 2010;111(4):1016–25.

    PubMed  Google Scholar 

  4. Sadler T. Special embryology, respiratory system. 7th ed. Baltimore: Williams and Wilkins; 1995. p. 232–71.

    Google Scholar 

  5. Mansfield L. Embryonic origins of the relation of gastro-esophageal reflux disease and airway disease. Am J Med. 2001;111(Suppl 8A):3S–7S.

    Article  PubMed  Google Scholar 

  6. Miller J, Sonies B, Macedonia C. Emergence of oropharyngeal, laryngeal and swallowing activity in the developing fetal upper aerodigestive tract: an ultrasound evaluation. Early Hum Dev. 2003;71:61–87.

    Article  PubMed  Google Scholar 

  7. Jadcherla S, Hogan W, Shaker R. Physiology and pathophysiology of glottic reflexes and pulmonary aspiration: from neonates to adults. Semin Respir Crit Care Med. 2010;31(05):554–60.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lang I, Shaker R. Anatomy and physiology of the upper esophageal sphincter. Am J Med. 1997;103(5A):50–5.

    Article  Google Scholar 

  9. Goyal R, Sivarao D. The esophagus. 3rd ed; 1999. p. 1–31.

    Google Scholar 

  10. Matsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys Med Rehabil Clin N Am. 2008;19(4):691–707.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Dodds W, Steward E, Logemann J. Physiology and radiology of the normal oral and pharyngeal phases of swallowing. Am J Roentgenol. 1990;154(5):953–63.

    Article  CAS  Google Scholar 

  12. Logemann J. Evaluation and treatment of swallowing disorders. 2nd ed: Pro-Ed; 1998.

    Google Scholar 

  13. Palmer J, Rudin N, Lara G, Crompton A. Coordination of mastication and swallowing. Dysphagia. 1992;7(4):187–200.

    Article  CAS  PubMed  Google Scholar 

  14. Hiiemae K, Palmer J. Food transport and bolus formation during complete feeding sequences on foods of different initial consistency. Dysphagia. 1999;14(1):31–42.

    Article  CAS  PubMed  Google Scholar 

  15. Dua K, Ren J, Bardan E, Xie P, Shaker R. Coordination of deglutitive glottal function and pharyngeal bolus transit during normal eating. Gastroenterology. 1997;112(1):73–83.

    Article  CAS  PubMed  Google Scholar 

  16. Shaker R, Dodds W, Dantas R, Hogan W, Arnodorfer R. Coordination of deglutitive glottic closure with oropharyngeal swallowing. Gastroenterology. 1990;98(6):1478–84.

    Article  CAS  PubMed  Google Scholar 

  17. Ohmae Y, Logemann J, Kaiser P, Hanson D, Kahrilas P. Timing of glottic closure during normal swallow. Head Neck. 1995;17(5):394–402.

    Article  CAS  PubMed  Google Scholar 

  18. Shaker R, Dodds W, Ren J, Hogan W. Esophagoglottal closure reflex: a mechanism of airway protection. Gastroenterology. 1992;102:857–61.

    Article  CAS  PubMed  Google Scholar 

  19. Shaker R, Ren J, Bardan E, et al. Pharyngoglottal closure reflex: characterization in healthy young, elderly and dysphagic patients with predeglutitive aspiration. Gerontology. 2003;49:12–20.

    Article  PubMed  Google Scholar 

  20. Dua K, Bardan E, Ren J, Sui Z, Shaker R. Effect of chronic and acute cigarette smoking on the pharyngoglottal closure reflex. Gut. 2002;51:771–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Limper AH, Prakash UB. Tracheobronchial foreign bodies in adults. Ann Intern Med. 1990;112(8):604–9.

    Article  CAS  PubMed  Google Scholar 

  22. Debeljak A, Sorli J, Music E, Kecelj P. Bronchoscopic removal of foreign bodies in adults: experience with 62 patients from 1974-1998. Eur Respir J. 1999;14(4):792–5.

    Article  CAS  PubMed  Google Scholar 

  23. Choroomi S, Curotta J. Foreign body aspiration and language spoken at home: 10-year review. J Laryngol Otol. 2011;125(07):719–23.

    Article  CAS  PubMed  Google Scholar 

  24. Hsu WC, Sheen TS, Lin CD, Tan CT, Yeh TH, Lee SY. Clinical experiences of removing foreign bodies in the airway and esophagus with a rigid endoscope: a series of 3217 cases from 1970 to 1996. Otolaryngol Head Neck Surg. 2000;122(3):450–4.

    Article  CAS  PubMed  Google Scholar 

  25. Cossellu G, Farronato G, Carrassi A, Angiero F. Accidental aspiration of foreign bodies in dental practice: clinical management and prevention. Gerodontology. 2015;32(3):229–33.

    Article  PubMed  Google Scholar 

  26. Lee P, Culver DA, Farver C, Mehta AC. Syndrome of iron pill aspiration. Chest J. 2002;121(4):1355–7.

    Article  Google Scholar 

  27. Jimenez Rodriguez BM, de Jesús SC, Merinas López CM, Gónzalez de Vega San Román JM, Romero Ortiz AD. Bronchial stenosis after iron pill aspiration. J Bronchol Interv Pulmonol. 2013;20(1):96–7.

    Article  Google Scholar 

  28. Carlborg B, Densert O. Esophageal lesions caused by orally administered drugs. An experimental study in the cat. Eur Surg Res. 1980;12(4):270–82.

    Article  CAS  PubMed  Google Scholar 

  29. Küpeli E, Khemasuwan D, Lee P, Mehta AC. “Pills” and the air passages. Chest. 2013;144(2):651–60.

    Article  PubMed  Google Scholar 

  30. Bond GR. The role of activated charcoal and gastric emptying in gastrointestinal decontamination: a state-of-the-art review. Ann Emerg Med. 2002;39(3):273–86.

    Article  PubMed  Google Scholar 

  31. Choi HS, Kim JO, Kim HG, Lee TH, Kim WJ, Cho WY, et al. A case of asymptomatic aspiration of a capsule endoscope with a successful resolution. Gut Liver. 2010;4(1):114–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Ernst A. Airway stabilization with silicone stents for treating adult tracheobronchomalacia. Chest. 2007;132(2):609–8.

    Article  PubMed  Google Scholar 

  33. Cavaliere S, Venuta F, Foccoli P, Toninelli C, La Face B. Endoscopic treatment of malignant airway obstructions in 2,008 patients. Chest J. 1996;110(6):1536–42.

    Article  CAS  Google Scholar 

  34. Ko H-K, Song H-Y, Shin JH, Lee GH, Jung H-Y, Park S-I. Fate of migrated esophageal and gastroduodenal stents: experience in 70 patients. J Vasc Interv Radiol. 2007;18(6):725–32.

    Article  PubMed  Google Scholar 

  35. Sloan PA, Hauter WE, Sloan PA, Hafner JW. Esophageal stent migration as a cause of severe upper airway obstruction. Emerg Med Open Access. 2014;04(04):1–3.

    Article  Google Scholar 

  36. Katsanos K, Sabharwal T, Koletsis E, Fotiadis N, Roy-Choudhury S, Dougenis D, et al. Direct erosion and prolapse of esophageal stents into the tracheobronchial tree leading to life-threatening airway compromise. J Vasc Interv Radiol. 2009;20(11):1491–5.

    Article  PubMed  Google Scholar 

  37. Khan AM, Pipkin M, Mozayyan S, Hwang D, Yasufuku K. Severe acute airway obstruction and respiratory failure with fibrous plug following photodynamic therapy (PDT): indication for early bronchoscopy and debridement. Photodiagn Photodyn Ther. 2014;11(2):254–8.

    Article  CAS  Google Scholar 

  38. Lan RS. Non-asphyxiating tracheobronchial foreign bodies in adults. Eur Respir J. 1994;7(3):510–4.

    Article  CAS  PubMed  Google Scholar 

  39. Casalini AG, Majori M, Anghinolfi M, Burlone E, D’Ippolito R, Toschi M, et al. Foreign body aspiration in adults and in children: advantages and consequences of a dedicated protocol in our 30-year experience. J Bronchol Interv Pulmonol. 2013;20(4):313–21.

    Article  Google Scholar 

  40. Mittleman RE, Wetli CV. The fatal cafe coronary. Foreign-body airway obstruction. JAMA. 1982;247(9):1285–8.

    Article  CAS  PubMed  Google Scholar 

  41. Cataneo AJM, Cataneo DC, Ruiz RL. Management of tracheobronchial foreign body in children. Pediatr Surg Int. 2008;24(2):151–6.

    Article  PubMed  Google Scholar 

  42. Sersar SI, Rizk WH, Bilal M, El Diasty MM, Eltantawy TA, Abdelhakam BB, et al. Inhaled foreign bodies: presentation, management and value of history and plain chest radiography in delayed presentation. Otolaryngol Head Neck Surg. 2006;134(1):92–9.

    Article  PubMed  Google Scholar 

  43. Zaupa P, Saxena AK, Barounig A, Höllwarth ME. Management strategies in foreign-body aspiration. Indian J Pediatr. 2009;76(2):157–61.

    Article  PubMed  Google Scholar 

  44. Viot A, Babin E, Bequignon A, Moreau S, Vadillo M, Valdazo A. Bronchial foreign bodies in children. Ann Otolaryngol Chir Cervicofac. 2002;119(3):174–80.

    CAS  PubMed  Google Scholar 

  45. Tokar B, Ozkan R, Ilhan H. Tracheobronchial foreign bodies in children: importance of accurate history and plain chest radiography in delayed presentation. Clin Radiol. 2004;59(7):609–15.

    Article  CAS  PubMed  Google Scholar 

  46. Heyer CM, Bollmeier ME, Rossler L, Nuesslein TG, Stephan V, Bauer TT, et al. Evaluation of clinical, radiologic, and laboratory prebronchoscopy findings in children with suspected foreign body aspiration. J Pediatr Surg. 2006;41(11):1882–8.

    Article  PubMed  Google Scholar 

  47. Haliloglu M, Ciftci AO, Oto A, Gumus B, Tanyel FC, Senocak ME, et al. CT virtual bronchoscopy in the evaluation of children with suspected foreign body aspiration. Eur J Radiol. 2003;48(2):188–92.

    Article  PubMed  Google Scholar 

  48. Sattar A, Ahmad I, Javed AM, Anjum S. Diagnostic accuracy of chest x-ray in tracheobronchial foreign body aspiration in paediatric patients. J Ayub Med Coll Abbottabad. 2011;23(4):103–5.

    PubMed  Google Scholar 

  49. Hong S-J, Goo HW, Roh J-L. Utility of spiral and cine CT scans in pediatric patients suspected of aspirating radiolucent foreign bodies. Otolaryngol Head Neck Surg. 2008;138(5):576–80.

    Article  PubMed  Google Scholar 

  50. Schumann C, Kropf C, Rudiger S, Wibmer T, Stoiber KM, Lepper PM. Removal of an aspirated foreign body with a flexible cryoprobe. Respir Care. 2010;55(8):1097–9.

    PubMed  Google Scholar 

  51. Miks VM, Kvale PA, Riddle JM, Lewis JW Jr. Broncholith removal using the YAG laser. Chest. 1986;90(2):295–7.

    Article  CAS  PubMed  Google Scholar 

  52. Lam YH, Ng EK, Chung SC, Li AK. Laser-assisted removal of a foreign body impacted in the esophagus. Lasers Surg Med. 1997;20(4):480–2.

    Article  CAS  PubMed  Google Scholar 

  53. Mosby’s Medical Dictionary. 9th ed. Elsevier; 2009.

    Google Scholar 

  54. Stedman’s Medical Dictionary for the Health Professionals and Nursing: Farlex; 2012.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Bronchoscopy and Interventional Pulmonology, Henry Ford Hospital, Wayne State University, 2799 West Grand Blvd, Detroit, MI, 48202, USA

    Michael Simoff MD & Harmeet Bedi MD

Authors
  1. Michael Simoff MD
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  2. Harmeet Bedi MD
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Correspondence to Michael Simoff MD .

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Editors and Affiliations

  1. Clínica Corachan and Bellvitge, University Hospital, Barcelona, Spain

    Jose Pablo Díaz-Jimenez

  2. Pulmonary Department, Clinica y Maternidad Colon, Pulmonary Research Department, IIC Mar del Plata, Buenos Aires, Argentina

    Alicia N. Rodriguez

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Simoff, M., Bedi, H. (2018). Foreign Bodies in the Airway: Endoscopic Methods. In: Díaz-Jimenez, J., Rodriguez, A. (eds) Interventions in Pulmonary Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-58036-4_36

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  • DOI: https://doi.org/10.1007/978-3-319-58036-4_36

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