Removal of an embedded gastric fishbone by traction-assisted endoscopic full-thickness resection

A 65-year-old man was referred to our hospital with a half-year history of upper abdominal pain. Endoscopy showed a submucosal eminence on the anterior wall of the gastric antrum ( Fig. 1 a ). Endoscopic ultrasonography (EUS) revealed a hyperechoic lesion in the gastric submucosa ( Fig. 2 ). A computed tomography (CT) scan showed a long, high density shadow in the gastric antrum, locally protruding into the serosal cavity ( Fig. 3 ). Emergency endoscopy was performed with the patient under general anesthesia and with endotracheal intubation ( Video 1 ).

Fig. 1.

Endoscopic images showing: a a submucosal eminence on the anterior wall of the gastric antrum; b partial exposure of the fishbone; c attempts to extract the fishbone using foreign body forceps; d snare traction being employed; e endoscopic full-thickness resection being performed; f closure of the perforation with metal clips.

Fig. 2.

Endoscopic ultrasonography image showing a hyperechoic lesion in the gastric submucosa.

Fig. 3.

Computed tomography images showing the location and depth of the fishbone (red arrow) on: a transverse plane; b coronal plane.

Download video file ^{(49MB, mp4)}

Removal of an embedded gastric fishbone by traction-assisted endoscopic full-thickness resection.

Video 1

The mucosa of the gastric antrum was circumferentially incised, exposing one side of the fishbone ( Fig. 1 b ). Attempts to extract it using foreign body forceps were unsuccessful, indicating significant adhesion with the surrounding tissues ( Fig. 1 c ). Snare traction was then employed ( Fig. 1 d ). Subsequently, we performed traction-assisted endoscopic full-thickness resection (EFTR), revealing that the base of the fishbone was enveloped within the omentum ( Fig. 1 e ). After the adhesions had been dissected, a 2.5-cm long fishbone was successfully extracted ( Fig. 4 ) and the perforation was immediately closed with several metal clips ( Fig. 1 f ). The operative and postoperative periods were uneventful, without any complications.

Fig. 4.

Photograph of the extracted fishbone.

A fishbone invading the intrinsic muscularis and serosa of the gastric wall is rare ¹ . Removal is often more challenging when there has been prolonged penetration of the gastric wall, and the risk of complications increases ^{2 3} . We performed traction using a snare combined with endoclips to assist in ETFR to successfully remove the fishbone. In this case, laparoscopic and open surgery were avoided.

Endoscopy_UCTN_Code_CCL_1AB_2AF

Funding Statement

Guangzhou Traditional Chinese Medicine and Traditional Chinese-Western Medicine Integration Science and Technology Project

Endoscopy E-Videos https://eref.thieme.de/e-videos .

E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos .