Esophageal foreign body extraction in children: flexible versus rigid endoscopy Jillian Popel • Hamdy El-Hakim • Wael El-Matary Received: 2 March 2010 / Accepted: 26 July 2010 / Published online: 24 August 2010 Ó Springer Science+Business Media, LLC 2010 Abstract Background Esophageal foreign body (FB) impaction is a common emergency in children. The goal of this study was to compare rigid versus flexible endoscopy in esophageal FB extraction in children. Methods In a retrospective cohort study with consecutive data, children with esophageal FB impaction who were admitted between January 2005 and December 2008 to the Stollery Children’s Hospital, Edmonton, Canada, were included. Nature of the procedure for FB removal (flexible vs. rigid endoscopy), duration of the procedure, compli- cations, and associated pathology were documented. Results A total of 140 children were included (81 boys; mean age, 59.8 ± 48.6 (range, 4–203) months). More than half (54%) of patients were aged 3 years or younger. Coins were the most common foreign body (77.9%). Flexible endoscopy was used in 89 patients, rigid in 49, and both in 2 patients. The mean duration of the endoscopic procedure was 10.50 ± 12.2 minutes for FE (95% confidence interval (CI), 7.94–13.08) and 16.49 ± 21.1 minutes for RE (95% CI, 13.75–22.45; p = 0.04). Biopsies were taken in 19% of patients undergoing FE and in 6% of RE (p = 0.04). Conclusions Both rigid and flexible endoscopy techniques appear to be equally safe and effective in esophageal foreign body extraction. However, performing flexible endoscopy for esophageal foreign body takes a substantial shorter duration compared with rigid endoscopy. Flexible endos- copy would probably allow a better and more thorough examination and, hence, biopsying esophageal mucosa compared with rigid endoscopy. Keywords Esophagus Á Foreign body Á Endoscopy Á Children Due to their high level of curiosity, infants and children commonly place various objects in their mouth. These objects usually pass through the entire gastrointestinal tract (GI) with no complications; however, in approximately 20% of cases, intervention by physicians is required to remove these objects due to the size, shape, type of foreign body (FB), or underlying pathology in the patient [1]. According to data from the 2007 Annual Report of the American National Poison Data System, there were 3,908 cases of ingested coins, and 1,222 required treatment in a healthcare facility [2]. This report, along with many other studies, supports the notion that coins are the most common FB ingested by children [3], but virtually any objects that children encounter can become lodged in the esophagus. Retained esophageal foreign bodies can lead to many complications, such as esophageal perforation [4], stricture formation [5], esophageal-aortic fistula [6], tracheoesoph- ageal fistula [7], respiratory distress with or without cya- nosis [8], mediastinal infection [9], altered mental status [10], and the potential progression to death [11]. That is why esophageal FB must be removed without delay once the diagnosis is made [11]. Both rigid and flexible endos- copy techniques are used for removal of esophageal FBs, but there remains a great deal of controversy on which J. Popel Faculty of Medicine, University of Alberta, Edmonton, Canada H. El-Hakim Pediatric Otolaryngology & Head and Neck Surgery, Stollery Children’s Hospital, Edmonton, Canada W. El-Matary (&) Division of Pediatric Gastroenterology, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK e-mail: wael.elmatary@alderhey.nhs.uk 123 Surg Endosc (2011) 25:919–922 DOI 10.1007/s00464-010-1299-0