An unexpected bite: Innovative endoscopic technique for removal of a metal grill brush bristle from the esophagus

Abstract

Ingestion of metal grill brush bristles is an uncommon but potentially serious cause of esophageal injury. We report a case of a healthy young man with acute odynophagia after eating grilled food, found to have a metal wire in the cervical esophagus. Given its partial embedding and sharp edges, standard removal methods were unsuccessful and posed risks. Using a snare, the bristle was successfully lassoed and withdrawn into the snare sheath before removal, preventing further trauma. The patient recovered fully without complications. This case demonstrates a novel, safe, and effective endoscopic technique for the removal of embedded metal wires such as grill brush bristles.

1. INTRODUCTION

The first reported case of accidental ingestion of a metal grill brush bristle was in 1951 involving a 19‐year‐old and resulting in an esophageal perforation. ¹ Over the subsequent decades, the safety of metal grill brushes used for maintenance of barbeque grills has remained a concern. Metal fragments from the brush can break off during use and become lodged in food, resulting in unintentional ingestion. Over the past 10 years in particular, several case reports have demonstrated complications of accidental ingestion including retained foreign bodies, esophageal perforation, intestinal and colonic perforation, abscess formation, vascular injury, and in some cases even death. ² , ³ , ⁴ , ⁵ , ⁶ , ⁷ , ⁸ , ⁹ In the United States, these products remain available on the market; however, they pose a significant safety concern with numerous consumer‐reported cases of accidental metal grill brush bristle ingestion. A recent systematic review found that when metal bristles were lodged in the upper aerodigestive tract, including the oropharynx and cervical esophagus, endoscopy led to successful retrieval in 41.7% of cases. ² When the bristles were more distal in the gastrointestinal (GI) tract, endoscopic retrieval via esophagogastroduodenoscopy (EGD) or colonoscopy was successful in 59.1% of cases. Procedurally, the endoscopic removal of metal bristles is challenging due to the low odds of visualization, their small size, high risk of moving during the procedure (including mucosal perforation) and difficulty in securing them for removal.

2. CASE REPORT

Here, we describe the case of a 16‐year‐old male with no significant past medical history who presented with 2 days of odynophagia with radiation to right lateral and posterior neck. The pain occurred acutely after eating tacos prepared on a grill. His symptoms persisted after the initial ingestion and were exacerbated by all swallowing including secretions. He denied associated nausea, vomiting, abdominal pain, shortness of breath, fevers/chills or other signs of systemic illness. Given symptoms were ongoing by day 2, patient presented to the emergency department for further evaluation.

In the emergency department, patient was afebrile and hemodynamically stable. His only complaint was the odynophagia described above. There was no evidence of respiratory distress, stridor, drooling, or voice changes; therefore, airway intervention was not required. On physical exam, he was generally well appearing with no focal tenderness to palpation. Two‐view X‐ray of the neck soft tissue was obtained which demonstrated a metal wire embedded in the proximal esophagus (Figure 1). Patient and family confirmed that a metal bristle brush was used to clean the grill on which the tacos had been cooked. Pediatric gastroenterology team was consulted for endoscopic removal. Otolaryngology was not consulted during this encounter.

Figure 1.

X‐ray of the neck soft tissue in posterior‐anterior (A) and lateral (B) views demonstrating metal wire embedded in the proximal esophagus (indicated by white arrow).

During the EGD, the metal wire was initially difficult to visualize however eventually noted in the upper esophageal sphincter, consistent with X‐ray imaging. Given the proximal location of the foreign body, an overtube was not used. Upon manipulation of the wire, it spontaneously migrated to the proximal esophageal lumen. Several attempts were made to remove the wire utilizing biopsy forceps and raptor forceps unsuccessfully due to inability to maintain adequate grip on the wire. Ultimately, the wire was removed utilizing a cold snare lassoing the wire, which was then closed, causing the wire to bend in half and be drawn into the outer tubing/sheath of the snare device and into the endoscope channel (Figure 2). The secured position of the wire allowed for easy removal of the endoscope without the risk the foreign body would be lost or cause further trauma along the way. The bent metal wire was easily removed from the snare device without reported damage to the endoscope. The patient tolerated the procedure without difficulty and was discharged from the emergency department with prescription for sucralfate as needed.

Figure 2.

Endoscopic removal. Endoscopic visualization of the metal wire embedded in the upper esophageal sphincter (A). Removed wire bent in half after having been lassoed utilizing the cold snare (B, C), with arrows highlighting the snare and outer sheath (C).

3. DISCUSSION

This case highlights the significant risk posed by metal grill brush bristles and describes the technical challenges associated with endoscopic retrieval of a small, sharp wire embedded in the esophagus. The technical difficulty of endoscopic metal wire retrieval underscores the importance of sharing procedural techniques and best practices among providers to improve outcomes in difficult foreign body removal. Compared with forceps or graspers, lassoing the wire with a snare and retracting it into the device sheath may reduce mucosal injury by shielding sharp edges during extraction and providing more stable control of the foreign body. While a foreign body hood can provide similar mucosal protection during sharp foreign body removal, its use typically requires initial control of the object with forceps, which was not achievable in this case. However, the effectiveness of this approach may depend on the material properties of the foreign body, as thicker or less pliable wires may not bend sufficiently or may be cut by the snare upon closure. In situations where the foreign body cannot be fully retracted into the sheath, effective lassoing may require a discrete portion of the object that can be securely captured or sufficient flexibility to allow bending during withdrawal. When feasible, this technique may also be used in combination with a foreign body hood to further protect the mucosa during extraction. Although otolaryngology (ENT) was not involved in this case, subsequent reflection highlights the potential value of collaboration for proximally located ingested metal wires, where adjunctive tools such as Magill forceps may facilitate removal under direct visualization. ¹⁰ As such, early ENT involvement should be considered in similar cases.

4. CONCLUSION

This case demonstrates a novel, safe, effective technique for endoscopic removal of an embedded metal grill brush bristle, potentially minimizing the risk of further injury. This technique adds to the range of available tools and approaches that may be employed in challenging foreign body retrieval cases. Multidisciplinary collaboration, including otolaryngology involvement and shared experience among gastroenterologists, may further improve management of complex foreign body cases.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

ETHICS STATEMENT

Verbal consent was obtained by the patient's parent/legal guardian for this case report. All identifying information has been removed.