I have observed extreme variation in how my colleagues manage GI foreign-body retrieval from the stomach. Some always use general anesthesia and endotracheal intubation; others (myself included) use conscious sedation. Some use an overtube to withdraw the object into if possible; others simply pull it up to the endoscope and use the endoscope to guide it through the esophagogastric junction and upper esophageal sphincter. The reasons for this variation are clearly related to the perceived risk of airway compromise or gastrointestinal wall injury during withdrawal of the object from the stomach.
So my questions to you are:
1) When do you ask for endotracheal intubation during foreign-body retrieval?
2) Do you use an overtube when removing foreign bodies from the stomach, and, if so, always or in what situations?
3) If you don’t use an overtube, what technique do you use during withdrawal of the object?
4) What is your favorite “tool” or endoscopic accessory to grab objects from the stomach?
I look forward to hearing your thoughts on this issue.
*This blog post was originally published at Gut Check on Gastroenterology*
Ruthie and Andrew
When I was diagnosed with leukemia my daughter, Ruthie, was just two and a half. She has vague memories of our household being turned upside down with worried, hushed conversations and friends and relatives calling A LOT. Because a leading specialist, Dr. Michael Keating from MD Anderson Cancer Center, advised against having treatment right away (something better was coming along), I did not have treatment for more than four years. By then Ruthie was seven. She has vivid memories then of me going off to Houston, accompanied by her mom, for a week of initial treatment and then successive weeks of treatment every month for quite a while back here in Seattle. She also remembers me tired, nauseous and, some days, in bed. The better memory is me participating in a clinical trial that worked and then returning to a full and active life.
Ruthie and I had never really talked about her observations of this until last night. Now, almost 18, Ruthie will be headed to college soon. It’s been a “journey.” As with many teenagers, they can be rebellious and oppositional, at times. But, in most cases, they eventually return to that loving person you remember. Ruthie has been making that return and, as she does, we’ve been talking more.
Last Friday night Ruthie called me in a panic. Read more »
*This blog post was originally published at Andrew's Blog*