Seo J K
Department of Pediatrics, College of Medicine, Seoul National University, Children's Hospital, Korea.
Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1997 May-Jun;38(3):183-6.
Endoscopic removal of foreign bodies (FBs) is an important part of therapeutic endoscopy in children. The majority of FB ingestion occur in children under 5 years. Children most often ingest coins, pins, keys, round stones or marbles, nails, rings, batteries and toys, and coins are the most common in the pediatric series of 139 children, who underwent endoscopic removal in Seoul National University, Children's Hospital. The management of FBs in children depends on the type (sharp or dull, pointed or blunt, and toxic or nontoxic) and the-size, along with the location of FB in the gastrointestinal tract. The endoscopist should decide whether endoscopic intervention is necessary and how urgently it has to be done. Indications for removal of FBs from the gastrointestinal tract in children are 1) all esophageal FBs. 2) gastric and duodenal FBs if they are sharp or pointed, if more than 4 cm long or 2 cm wide in young infants and children, if containing toxic substances and if blunt objects after 2 weeks observation in the stomach or 1 week observation in the duodenum. All FBs impacted in the esophagus should be removed within 24 hours because of the risks of perforation and serious fistula formation. Disk batteries can cause corrosive injury to the esophagus within 4 hours, and should be removed as soon as possible. Coin retrieval can be done very securely by the W-shape FB grasping forcep without an endotracheal general anesthesia. Blunt FBs, such as marbles can be best removed with a stone retrieval basket, which can be made from a condom. Disk batteries can not be grasped with the FB forceps and snares, but very safely with the powerful magnet attached to the tip of the scope. Overtubes and protective rubber hoods are useful for removing sharp or pointed objects. It is important to test the available grasping accessories on a duplicate of the FB as a "dry run" to determine which accessories will grasp the FB securely.
内镜下取出异物是儿童治疗性内镜检查的重要组成部分。大多数异物摄入发生在5岁以下儿童。儿童最常摄入硬币、别针、钥匙、圆形石头或弹珠、钉子、戒指、电池和玩具，在首尔国立大学儿童医院接受内镜取出的139例儿科病例系列中，硬币是最常见的。儿童异物的处理取决于异物的类型（尖锐或钝圆、有尖或无尖、有毒或无毒）、大小以及在胃肠道中的位置。内镜医师应决定是否有必要进行内镜干预以及干预的紧急程度。儿童胃肠道异物取出的指征为：1）所有食管异物。2）胃和十二指肠异物，如果是尖锐或有尖的，在幼儿和儿童中长度超过4厘米或宽度超过2厘米，含有有毒物质，以及钝性物体在胃内观察2周或在十二指肠内观察1周后。所有嵌顿在食管的异物应在24小时内取出，因为有穿孔和严重瘘管形成的风险。圆盘电池可在4小时内对食管造成腐蚀性损伤，应尽快取出。使用W形异物抓取钳无需气管内全身麻醉即可非常安全地取出硬币。钝性异物，如弹珠，最好用避孕套制成的结石取出篮取出。圆盘电池不能用异物钳和圈套器抓取，但用附着在镜端的强力磁铁可以非常安全地取出。外套管和保护性橡胶罩对于取出尖锐或有尖的物体很有用。重要的是在异物的复制品上进行“预演”，测试可用的抓取附件，以确定哪些附件能牢固地抓取异物。
