Treatment of Upper Gastrointestinal Foreign Bodies with Different Endoscopic Instruments: A Retrospective Analysis

Treatment of Upper Gastrointestinal Foreign Bodies with Different Endoscopic Instruments: A Retrospective Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Treatment of Upper Gastrointestinal Foreign Bodies with Different Endoscopic Instruments: A Retrospective Analysis hanfeng Lv, linzhen zhu, heng yang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4276777/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: This study aimed to compare the performance and safety of two types of endoscopic instruments, serrated biopsy forceps and foreign body retrieval forceps, for removing upper gastrointestinal foreign bodies. Materials and Methods: We conducted a retrospective analysis of 143 cases from January 1, 2016, to December 1, 2022. Patients were divided into two groups based on the instruments used: serrated biopsy forceps (48 cases) and foreign body retrieval forceps (95 cases). We collected data on patient demographics, retrieval success rates, postoperative complications, and characteristics of the foreign bodies. Statistical analysis was performed using SPSS software version 26.0 (IBM Corp., Armonk, NY, USA). Results: In the 143 cases, the serrated biopsy forceps group had 45 successful retrievals and 3 failures, while the foreign body retrieval forceps group had 82 successful retrievals and 13 failures. There were significant differences in the types and categories of successfully retrieved foreign bodies between the two groups (P<0.05). Conclusion: Flexible endoscopic serrated biopsy forceps are effective for extracting elongated and small flat foreign bodies such as fish bones and poultry bones in the upper gastrointestinal tract. Due to their advantages in terms of cost and flexibility, serrated biopsy forceps can be given priority when considering the removal of such foreign bodies. Upper gastrointestinal foreign body biopsy forceps foreign body retrieval forceps retrospective analysis Figures Figure 1 Introduction Zhejiang Province is located in the eastern coastal region of China. With a developed economy and high standard of living for its people, the consumption of food such as chicken, duck, and fish has significantly increased at dining tables. However, as the variety of food increases, the probability of foreign bodies becoming lodged in the upper gastrointestinal tract also rises. Research indicates[1], Ingestion of fish bones was more common in patients from coastal areas, whereas ingestion of food boluses and bony material was more common in patients from inland areas.A recent study indicates[2], The majority of upper gastrointestinal foreign body incidents occur in the esophagus, and children remain the most susceptible group to foreign body impaction. What sets it apart from the past is a decline in cases involving the ingestion of coins, while the incidence of foreign bodies with a length of ≥6 cm is on the rise. The harm of foreign bodies in the upper digestive tract to the human body is inevitable, and the extent of their impact on the human body depends on the location of the foreign body impaction, the type of foreign body, and the size of the foreign body[3]. Guidelines from ESGE (European Society of Gastrointestinal Endoscopy) state that cases such as complete esophageal obstruction, impaction of sharp objects in the esophagus, and impaction of button batteries in the esophagus require urgent endoscopic intervention (preferably within 2 hours, but no later than 6 hours)[4]. Foreign body ingestion is a common reason for emergency endoscopic examinations. Flexible endoscopy is considered a non-invasive procedure. The endoscope is equipped with accessory channel that allow specialized instruments such as biopsy forceps, foreign body forceps, nets, snares, and other accessories to pass through. Flexible endoscopy is the preferred diagnostic and therapeutic method for upper digestive tract foreign bodies and impacted food masses, with a success rate exceeding 95%, and a complication rate ranging from 0% to 5%.[5]. Previous studies have indicated that coins, fish bones, dentures, and similar objects are typically removed using foreign body forceps. On the other hand, smooth and round objects are more suitable for retrieval using snares or retrieval baskets [6-7]. With the continuous improvement of biopsy forceps production technology, the jaws of the forceps are designed to be serrated. This design makes the jaws sharper, enabling more effective grasping of biopsy specimens while also providing good gripping force to prevent objects from slipping during retrieval. Both serrated biopsy forceps and foreign body forceps are commonly used tools for foreign body retrieval, but each has its own advantages and disadvantages. In this study, we conducted a retrospective analysis of 143 cases of endoscopic foreign body removal in our hospital from January 1, 2016, to December 1, 2022. By comparing the efficacy of different tools in foreign body removal, we can offer healthcare professionals additional clinical guidelines and best practice recommendations. This can contribute to improving patient treatment outcomes and reducing potential complications. Accidental ingestion or aspiration of foreign bodies is a common medical emergency that can pose a threat to the health of patients.By determining the most effective tools, we can better ensure patient safety and reduce unnecessary risks. Knowing which tool is more effective can also assist healthcare institutions in more efficiently allocating resources, enhancing the efficiency of medical services, lowering costs, and ensuring that patients receive high-quality care. Materials And Methods 2.1 General Information This study included a total of 143 patients with confirmed upper gastrointestinal foreign bodies, among whom there were 62 male and 81 female patients, ranging in age from 4 to 85 years (mean age of 44.4 ± 17.5 years). A total of 127 cases of foreign body impaction were successfully removed, with 45 cases (35.43%) using serrated biopsy forceps and 82 cases (64.57%) using foreign body forceps. There were 16 cases of unsuccessful removal, with 3 cases (18.75%) using serrated biopsy forceps and 13 cases (81.25%) using foreign body forceps. 2.2 Equipment and Materials 2.2.1 Medical devices Gastroscopes: Olympus Corporation, Japan (including models GIF-H260, GIF-H260Z, GIF-Q260J, GIF-H290). Serrated biopsy forceps: Boston Scientific Corporation. Foreign body forceps: Olympus Corporation, Japan; ENDO-FLEX Corporation, Germany. Transparent cap: Olympus Corporation, Japan. 2.2.2 Medications Lidocaine Gel: Manufactured by Xinyu Boyuan Biochemical Medical Supplies Co., Ltd., and Handan Kangye Pharmaceutical Co., Ltd. 2.3 Methods 2.3.1 Nursing cooperation Prior to the procedure, nurses prepared the appropriate endoscopic equipment and surgical accessories based on factors such as the type, nature, and size of the foreign body, as well as the physician's preferred techniques. When necessary, a transparent cap was attached to the distal end of the endoscope to aid in foreign body retrieval and to protect the esophageal mucosa. Patients undergoing local anesthesia were asked to hold 5-7 ml of lidocaine gel in their mouth and swallow it after 5 minutes. Assisting the patient to assume a left lateral position[8], removing any removable dentures, having the patient bite on a dental pad, and guiding them to maintain relaxation and avoid tension were considered essential for ensuring smooth collaboration between the patient and the physician. Upon discovering a foreign body, selecting the appropriate foreign body forceps or serrated biopsy forceps based on the characteristics of the foreign body, adjusting to the optimal angle, and facilitating the smooth removal of the foreign body along with the endoscope were crucial steps. To minimize damage to the gastric and esophageal mucosa from sharp foreign bodies, special attention was given during the foreign body removal process. When the foreign body was located in the upper esophagus or pharyngeal area, it was vital to securely grip the foreign body to prevent it from becoming loose, thereby avoiding the risk of the foreign body entering the trachea and causing injury, asphyxiation, or the danger of airway obstruction. Throughout the surgical procedure, close monitoring of the patient's vital signs and changes in their medical condition was imperative[9]. 2.3.2 Postoperative Care After the procedure, the physician used the endoscope again to observe whether there was any damage to the mucosa. In the case of bleeding, local application of epinephrine or clotting enzyme was used for hemostasis[9]. Patients were advised to consume warm and liquid food within two hours after the surgery, and if no adverse reactions such as coughing occur, they were allowed to proceed to a semiliquid diet. Within 24 hours after the surgery, close observation was carried out to detect the occurrence of complications such as subcutaneous emphysema and gastrointestinal bleeding. Additionally, patients were informed about the importance of seeking timely medical attention if any complications arose. For individuals with self-harming tendencies, psychological counseling and health guidance were provided[9]. 2.3.3 Admission Criteria The endoscopic reports and images encompassed essential patient details such as the name, sex, age, type of foreign body, category, and location of impaction. Additionally, they included pertinent information about the accessories employed for foreign body removal and descriptions of any complications arising from the removal procedure. 2.3.4 Data analysis The 143 cases of upper gastrointestinal foreign bodies were categorized into the serrated biopsy forceps group (48 cases) and the foreign body forceps group (95 cases) based on the types of endoscopic accessories used. Among these two groups, a total of 127 cases with successfully removed foreign bodies were selected. According to the information in the endoscopic reports, the patients with foreign body impaction were divided into three age groups: children (below 14 years), young and middle-aged adults (14-59 years), and elderly individuals (60 years and above), aiming to analyze the age and sex distribution of successfully removed foreign bodies using serrated biopsy forceps and foreign body forceps. Additionally, the occurrences of different foreign body impaction sites (pharynx, upper esophagus, middle esophagus, lower esophagus, and stomach) were recorded and analyzed. The chi-square test was utilized to calculate and verify whether there were differences in the effectiveness of the two forceps in extracting foreign bodies from different locations. Based on the various categories of foreign bodies, they were classified as fish bones, poultry bones, other fragmented bones (from pigs, cows, sheep, frogs, etc.), fruit pits, and other categories (food masses, toothpicks, metals, dentures, and pen caps). Furthermore, these foreign bodies were categorized based on their shapes into fine needle-like, flat piece-like, irregular-shaped, and other types (spindle-shaped, food masses, elongated blunt shapes, and rounded blunt shapes). The same statistical approach was employed to compare whether there were differences in the effectiveness of the two forceps in extracting foreign bodies of different categories and shapes. Complications arising from endoscopic procedures were recorded and analyzed to compare the safety of the two forceps. Moreover, we reviewed the intraoperative descriptions of the 16 cases of unsuccessful removal from both groups to analyze the reasons for the failures. 2.4 Ethical-considerations This study has been approved by the Ethics Committee for Human Research at the Fourth Affiliated Hospital of Zhejiang University School of Medicine.(Approval NO.K2023110). Results 3.1 Comparison of Successfully Removed Foreign Bodies between the Two Groups A total of 127 cases with successfully removed foreign bodies were analyzed. Table 1 presents the sex distribution in the serrated biopsy forceps group and foreign body forceps group, with a slightly higher prevalence of females in both groups. In the serrated biopsy forceps group, no cases were reported for children (below 14 years old), with the cases predominantly comprising middle-aged individuals (14-59 years), while cases involving elderly adults (60 years and above) were relatively few. Similarly, in the foreign body forceps group, middle-aged cases were the most prevalent, followed by a relatively higher proportion of elderly cases compared to the biopsy forceps group. Additionally, a small number of pediatric cases (below 14 years old) were observed in the foreign body forceps group, as depicted in Table 1. In the reports of successful removal in the serrated biopsy forceps group and the foreign body forceps group, there was minimal difference in the number of cases located in the pharynx, middle esophagus, and lower esophagus. However, for cases located in the upper esophagus, the foreign body forceps group exhibited a higher count than the serrated biopsy forceps group, although this difference lacked statistical significance between the two groups (P>0.05), as shown in Table 2. The number of successfully removed fish bones did not significantly differ between the two groups. However, in the foreign body forceps group, there were more successfully removed foreign bodies of categories such as poultry bones, other fragmented bones (from pig, cow, sheep, frog, etc.), fruit pits, and other types (food masses, toothpicks, metal objects, dentures, pen caps, etc.), compared to the serrated biopsy forceps group. This difference between the two groups was statistically significant (P<0.05), as shown in Table 2. In this study, the foreign bodies were categorized into four types based on their different shapes. Among the fine needle-shaped foreign bodies, fish bones were the most common, with comparable numbers of successfully removed cases in both groups. Among flat-shaped foreign bodies, poultry bones were the most prevalent, followed by other fragmented bones (from pigs, cows, sheep, frogs, etc.), with fish bones being relatively less common. In this category, the serrated biopsy forceps group had significantly fewer successful removals compared to the foreign body forceps group, as shown in Tables 2 and 3. Irregular-shaped foreign bodies were less common, and they were often associated with fish bones and other fragmented bones (from pigs, cows, sheep, frogs, etc.). The numbers of these foreign bodies were similar between the two groups. Other types of foreign bodies (such as spindle-shaped, lumpy, elongated, and rounded) were commonly found in fruit pits and other miscellaneous items (food masses, toothpicks, metal objects, dentures, pen caps, etc.). Interestingly, the serrated biopsy forceps group had no cases of this type, while the foreign body forceps group successfully removed 17 cases. This difference between the two groups was statistically significant (P<0.05), as shown in Tables 2 and 3. In the group where serrated biopsy forceps were used for successful foreign body removal, there were no cases of mucosal injury. In the group where foreign body forceps were used, there were 5 cases of mucosal injury, as shown in Table 4. 3.2 Results of Failed Foreign Body Removal In this study, within the group using serrated forceps, there were 3 cases of failed foreign body retrieval, all of which involved thin needle-like fish bones (Table 5 and Table 6). Among these cases, 2 failures were attributed to patients experiencing nausea and vomiting during the procedure, and 1 case resulted from the slipping of a thin needle-like fish bone during retrieval attempts. In the group using foreign body forceps, there were a total of 13 cases of unsuccessful foreign body retrieval. Fish bones and other fragmented bones (such as from pigs, cows, sheep, frogs, etc.) were the most commonly encountered types of foreign bodies in these failures. Additionally, there were a few cases involving poultry bones and other objects (such as food masses, toothpicks, metal objects, dentures, and pen caps). Among the different types of foreign bodies, flat fragments were the most prevalent, followed by thin needle-like shapes and irregular shapes, while other types (spindle-shaped, clumps, blunt long shapes, round blunt shapes, etc.) were less common (Table 5 and Table 6). Among the 13 cases of retrieval failures, 7 were attributed to patients experiencing nausea and vomiting, which hindered the retrieval process. Three cases resulted from the brittleness of the foreign body, causing it to break during retrieval attempts. Two cases involved the foreign body slipping from the forceps, and in 1 case, the foreign body was too large for successful retrieval. Discussion Unlike previous reports where the proportion of males was higher than that of females[7,10], the results of this study showed a different trend. Among the patients with upper gastrointestinal foreign bodies, there were 71 females (55.91%) and 56 males (44.09%). This discrepancy could be attributed to the exclusion of incomplete reports during the data collection process. The management guidelines for ingested foreign bodies in the United States indicate that most cases occur in the pediatric population, with the highest incidence observed among children aged 6 months to 6 years. Among adults, genuine instances of foreign body ingestion often occur in individuals with mental disorders, intellectual disabilities, or alcohol-induced impairments, or in individuals seeking secondary gains through medical facilities. Cases involving the ingestion of multiple foreign bodies and recurrent incidents are not uncommon. Additionally, toothless adults, including those with dentures, face a higher risk of foreign body ingestion[6]. In our study data, the highest proportion of patients were in the middle-aged to young-adult group (14-59 years), accounting for 76.38% of cases. The elderly group (60 years and above) followed, while the pediatric group (below 14 years) had the lowest representation at 1.57%. This distribution might be correlated with the fact that the study was conducted in a comprehensive adult hospital setting. There are four potential anatomically narrow regions in the esophagus that may be affected by foreign bodies, including the upper esophageal sphincter, aortic arch level, tracheobronchial crossing, lower esophageal sphincter, and gastroesophageal junction. Notably, the most pronounced narrowing occurs at the cricopharyngeus muscle at the entrance of the esophagus, which contributes to the higher incidence of foreign body impaction[11]. In our study, both the group treated with serrated biopsy forceps and the group treated with foreign body forceps underwent successful removal of foreign bodies primarily located in the upper esophagus, consistent with previous reports[12-13]. Both serrated biopsy forceps and foreign body forceps can freely open and close when removing foreign bodies from different positions in the upper digestive tract, and there was no significant difference in the statistical analysis of the data between the two groups. The Zhejiang region boasts a well-developed fishing industry, and fish are a common staple in the daily diet of its residents. Local people tend to consume fish without removing the bones, resulting in bones being mixed with meat and soup. This practice increases the likelihood of fish bone ingestion[14]. In our study, fish bones were also the most frequently lodged foreign bodies. The numbers of successful and failed removal cases were relatively similar between the serrated biopsy forceps group and the foreign body forceps group regarding the extraction of fish bones. Hence, both serrated biopsy forceps and foreign body forceps exhibited comparable efficacy in removing fish bones. Regarding categories such as poultry bones, other fragmented bones (pork, beef, lamb, frog, etc.), fruit pits, and other objects (food clusters, toothpicks, metal, dentures, pen caps, etc.), there were significant differences in the quantities extracted between the serrated biopsy forceps group and the foreign body forceps group. These types of foreign bodies often have larger sizes or harder textures. Foreign body forceps excel in terms of their wider opening size and gripping force, making them more effective for extracting such larger or harder foreign bodies. This finding aligns with previous reports[6,7,15,16]. Concerning different types of foreign bodies, there were distinct differences between the serrated biopsy forceps group and the foreign body forceps group. For needle-like foreign bodies, both groups had similar successful extraction rates. However, for flat-shaped foreign bodies, the friction against the esophageal wall increases with the size of the foreign body, making it more challenging to remove. Therefore, foreign body forceps were preferred for extracting these larger foreign bodies. Moreover, when dealing with other types of foreign bodies (spindle-shaped, food clusters, blunt long shapes, rounded blunt shapes), foreign body forceps were also predominantly used. These types of foreign bodies are commonly associated with fruit pits, food clusters, toothpicks, metal, dentures, and pen caps, making foreign body forceps a more effective choice than serrated biopsy forceps. Among the 127 successfully removed upper digestive tract foreign bodies in this study, only 5 cases that were extracted using foreign body forceps exhibited mucosal injuries. This phenomenon can be attributed to the larger size of the foreign bodies typically removed with foreign body forceps, leading to more intense patient reactions during the procedure. To address this issue, preoperative evaluation of the foreign body's size should be conducted, and the use of an endoscopic transparent cap should be considered in advance. The transparent cap serves to widen narrow physiological areas, providing clearer visibility of the impacted foreign body and creating a larger operational space for its extraction. This measure safeguards the esophageal mucosa from sharp foreign body-induced injuries during the extraction process[17]. The extraction of upper digestive tract foreign bodies requires a high level of patient cooperation during the procedure. In this study, almost half of the 16 cases of failure were attributed to patients experiencing nausea and vomiting during the procedure. Reports indicate[17,18] that some higher-risk cases with challenging foreign body removal or younger pediatric patients may necessitate the use of intravenous sedation or general anesthesia. This approach ensures the successful completion of the procedure and minimizes complications arising from patient discomfort or involuntary movements. This study exclusively included non-painless cases from our hospital and excluded some cases with incomplete information in the doctors' reports during data collection. Therefore, this study has limitations, including a wide sampling time span and a relatively small sample size. Conclusion Flexible endoscopic serrated biopsy forceps are effective for the retrieval of small and slender flat foreign objects such as fish bones and poultry bones from the upper gastrointestinal tract. In comparison to foreign body forceps, serrated biopsy forceps have lower costs, greater flexibility in usage, and no significant differences in operation-related complications. Therefore, when extracting small and slender flat foreign objects, serrated biopsy forceps are considered the primary choice. Declarations This article is an original research work and has not been previously published or submitted to other journals. All materials and viewpoints cited in this article have been appropriately referenced and sourced. The authors acknowledge and fully respect the research and contributions of others, and have not engaged in plagiarism or infringed upon the intellectual property of others. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Disclosures Drs. Hanfeng Lv,Linzhen Zhu and Heng Yang,have no conflicts of interest or financial ties to disclose. Data availability statement The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Acknowledgements Not applicable. References Yoo DR, Im CB, Jun BG, et al. Clinical outcomes of endoscopic removal of foreign bodies from the upper gastrointestinal tract. BMC Gastroenterol. 2021;21(1):385. Published 2021 Oct 19. DOI:10.1186/s12876-021-01959-3 Lin, C., Lin, Q., & Zheng, W. Epidemiological Investigation of Gastrointestinal Foreign Bodies Over Ten Years and Analysis of Factors Affecting Complications [J]. Chinese Journal of Endoscopy,2023, 29(09), 49-56. Choe JY, Choe BH. Foreign Body Removal in Children Using Foley Catheter or Magnet Tube from Gastrointestinal Tract. Pediatr Gastroenterol Hepatol Nutr. 2019;22(2):132-141. doi:10.5223/pghn.2019.22.2.132 Birk M, Bauerfeind P, Deprez PH, Häfner M, Hartmann D, Hassan C, Hucl T, Lesur G, Aabakken L, Meining A. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy （ESGE） Clinical Guideline. Endoscopy. 2016 May;48（5）:489-96. doi: 10.1055/s-0042-100456. Mosca S, Manes G, Martino R, et al.. Endoscopic management of foreign bodies in the upper gastrointestinal tract: report on a series of 414 adult patients. Endoscopy. 2001 Aug;33(8):692-6.doi: 10.1055/s-2001-16212 Eisen GM, Baron TH, Dominitz JA, et al. Guideline for the management of ingested foreign bodies. Gastrointest Endosc. 2002 Jun;55(7):802-6.doi:10.1016/s0016-5107(02)70 407-0 Li ZS, Sun ZX, Zou DW, et al. 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Evaluation of the medical economics and safety: two methods for the endoscopic removal of jujube pits. Rev Esp Enferm Dig. 2019;111(3):209-213. doi:10.17235/reed.2018.5794/2018 Yuan, F, Gong W, et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract: An analysis of 846 cases in China. Experimental and therapeutic medicine vol. 15,2 (2018): 1257-1262. doi:10.3892/etm.2017.5561 Pang Q, Quan X, Zhu L, et al. [Cooperative Techniques and Nursing Care for Endoscopic Forceps Removal of Pediatric Upper Gastrointestinal Foreign Bodies]. Guizhou Medical Journal, 2013, 37(10): 955-956.Chinese. Tables Table 1. Distribution of Successfully Removed Foreign Body Patients by Sex and Age Types of Forceps Total [Cases (%)] Serrated Biopsy Forceps Group/[Cases (%)] Foreign Body Forceps Group/[Cases (%)] Sex Male 19（42.22） 37（45.12） 56（44.09） Female 26（57.78） 45（54.88） 71（55.91） Age Children (below 14 years) 0（0） 2（2.44） 2（1.57） Young and middle-aged adults (14-59 years) 41（91.11） 56（68.29） 97（76.38） Elderly adults (60 years and above) 4（8.89） 24（29.27） 28（22.05） Total 45（35.43） 82（64.57） 127（100） Table 2. Chi-Square Test for Comparison of Successfully Removed Foreign Bodies between the Serrated Biopsy Forceps and Foreign Body Forceps Groups Types of Forceps X 2 P value Serrated Biopsy Forceps Group Foreign Body Forceps Group Impaction Location 4.230 0.342 Pharynx 3 1 Upper esophagus 34 67 Middle esophagus 5 6 Lower esophagus 1 1 Stomach 2 7 Foreign Body Category 18.547 0.001 Fish bones 27 21 Poultry bones 11 23 Other fragmented bones (from a pig, cow, sheep, frog, etc.) 5 19 Fruit pits 0 11 Other Categories (food bolus, toothpick, metal objects, dentures, pen caps, etc.) 2 8 Foreign Body Type 13.658 0.003 Needle-Like 19 18 Flat-Shaped 21 40 Irregular Shapes 5 7 Other Types (Spindle-Shaped, Food Bolus, Long Blunt, Rounded Blunt, etc.) 0 17 Table 3. Cross-Tabulation of Successfully Removed Foreign Body Types and Categories Foreign Body Category Total Fish bones Poultry bones Other fragmented bones (from pig, cow, sheep, frog, etc.) Fruit pits Other Categories (food bolus, toothpick, metal objects, dentures, pen caps, etc.) Foreign Body Type Needle-Like 32 1 1 0 3 37 Flat-Shaped 10 31 20 0 0 61 Irregular Shapes 6 2 3 0 1 12 Other Types (Spindle-Shaped, Food Bolus, Long Blunt, Rounded Blunt, etc.) 0 0 0 11 6 17 Total 48 34 24 11 10 127 Table 4. Cross-tabulation of Mucosal Injury in Patients with Successful Foreign Body Removal by Type of Forceps Used Types of Forceps Total Serrated Biopsy Forceps Group Foreign Body Forceps Group Mucosal Injury No 45 77 122 Yes 0 5 5 Total 45 82 127 Table 5. Cross-Tabulation of Failed Foreign Body Categories and Forceps Types Types of Forceps Total Serrated Biopsy Forceps Group Foreign Body Forceps Group Foreign Body Category Fish bones 3 5 8 Poultry bones 0 1 1 Other fragmented bones (from a pig, cow, sheep, frog, etc.) 0 5 5 fruit pits 0 0 0 Other categories (food bolus, toothpick, metal objects, dentures, pen caps, etc.) 0 2 2 Total 3 13 16 Table 6. Cross Table of Failed Extraction: Type of Foreign Object and Type of Forceps Types of Forceps Total Serrated Biopsy Forceps Group Foreign Body Forceps Group Needle-Like 3 3 6 Flat-Shaped 0 6 6 Irregular Shapes 0 2 2 Other Types (Spindle-Shaped, Food Bolus, Long Blunt, Rounded Blunt, etc.) 0 2 2 Total 3 13 16 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4276777","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":292949445,"identity":"629384aa-03bd-434d-91c0-61d85f660a4d","order_by":0,"name":"hanfeng Lv","email":"","orcid":"","institution":"Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"hanfeng","middleName":"","lastName":"Lv","suffix":""},{"id":292949446,"identity":"fa24a134-07fa-4167-9191-9e41b8386822","order_by":1,"name":"linzhen zhu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYBACNvmDDQaJf2zkGBgOgLhEaOGTYD5Q8LAhzZh4LXISbAkfHzYcTmyAWEqMw6R7DDck7mBOn994xoDhQ9lhBv7ZDQS0yJwxNkg8w5bb2HDGgHHGucMMEncOENDCkGNmkMDGk9vMcMaAmbftMIOBRAJBLeY/Etgk0tlAWv4SpUUiLcEgsc0ggQekhZEoLTyHDxgknEkwnMFwrOBgz7l0HokbBLTItzc2GP6o+C8vP+Pwxgc/yqzl+GcQ0IIAEgfAkclDrHog4G8gQfEoGAWjYBSMKAAABwxE6QGcwlAAAAAASUVORK5CYII=","orcid":"","institution":"Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"linzhen","middleName":"","lastName":"zhu","suffix":""},{"id":292949447,"identity":"757ed5fd-1837-4145-ae92-9ce33a724f63","order_by":2,"name":"heng yang","email":"","orcid":"","institution":"Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"heng","middleName":"","lastName":"yang","suffix":""}],"badges":[],"createdAt":"2024-04-16 14:38:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4276777/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4276777/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55509137,"identity":"240680c9-299a-403b-82a3-9de65727e58e","added_by":"auto","created_at":"2024-04-29 12:20:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28701691,"visible":true,"origin":"","legend":"\u003cp\u003eUsing serrated biopsy forceps and foreign body forceps to extract different types of foreign objects.\u003c/p\u003e\n\u003cp\u003eA: Serrated biopsy forceps were used to extract flat-shaped duck bones; B: Serrated biopsy forceps were used to extract irregularly shaped bone fragments;C: Serrated biopsy forceps were used to extract flat-shaped fish bones; D: Serrated biopsy forceps were used to extract irregularly shaped dentures; E: Foreign body forceps were used to extract flat-shaped duck bones; F: Foreign body forceps were used to extract flat-shaped fish bones; G: Foreign body forceps were used to extract irregularly shaped bone fragments; H: Foreign body forceps were used to extract flat-shaped bone fragments.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4276777/v1/4210269501deac889b3b78a2.png"},{"id":55510144,"identity":"b5a7b18c-c5c3-4fc5-ace4-cc635862a51a","added_by":"auto","created_at":"2024-04-29 12:28:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":616252,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4276777/v1/b0c52fcd-0219-4f41-8f35-5c30b069ef65.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Treatment of Upper Gastrointestinal Foreign Bodies with Different Endoscopic Instruments: A Retrospective Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eZhejiang Province is located in the eastern coastal region of China. With a developed economy and high standard of living for its people, the consumption of food such as chicken, duck, and fish has significantly increased at dining tables. However, as the variety of food increases, the probability of foreign bodies becoming lodged in the upper gastrointestinal tract also rises. Research indicates[1], Ingestion of fish bones was more common in patients from coastal areas, whereas ingestion of food boluses and bony material was more common in patients from inland areas.A recent study indicates[2],\u0026nbsp;The majority of upper gastrointestinal foreign body incidents occur in the esophagus, and children remain the most susceptible group to foreign body impaction. What sets it apart from the past is a decline in cases involving the ingestion of coins, while the incidence of foreign bodies with a length of \u0026ge;6 cm is on the rise.\u003c/p\u003e\n\u003cp\u003eThe harm of foreign bodies in the upper digestive tract to the human body is inevitable, and the extent of their impact on the human body depends on the location of the foreign body impaction, the type of foreign body, and the size of the foreign body[3]. Guidelines from ESGE (European Society of Gastrointestinal Endoscopy) state that cases such as complete esophageal obstruction, impaction of sharp objects in the esophagus, and impaction of button batteries in the esophagus require urgent endoscopic intervention (preferably within 2 hours, but no later than 6 hours)[4].\u003c/p\u003e\n\u003cp\u003eForeign body ingestion is a common reason for emergency endoscopic examinations. Flexible endoscopy is considered a non-invasive procedure. The endoscope is equipped with accessory channel that allow specialized instruments such as biopsy forceps, foreign body forceps, nets, snares, and other accessories to pass through. Flexible endoscopy is the preferred diagnostic and therapeutic method for upper digestive tract foreign bodies and impacted food masses, with a success rate exceeding 95%, and a complication rate ranging from 0% to 5%.[5].\u0026nbsp;Previous studies have indicated that coins, fish bones, dentures, and similar objects are typically removed using foreign body forceps. On the other hand, smooth and round objects are more suitable for retrieval using snares or retrieval baskets [6-7].\u0026nbsp;With the continuous improvement of biopsy forceps production technology, the jaws of the forceps are designed to be serrated. This design makes the jaws sharper, enabling more effective grasping of biopsy specimens while also providing good gripping force to prevent objects from slipping during retrieval.\u0026nbsp;Both serrated biopsy forceps and foreign body forceps are commonly used tools for foreign body retrieval, but each has its own advantages and disadvantages.\u003c/p\u003e\n\u003cp\u003eIn this study, we conducted a retrospective analysis of 143 cases of endoscopic foreign body removal in our hospital from January 1, 2016, to December 1, 2022.\u0026nbsp;By comparing the efficacy of different tools in foreign body removal, we can offer healthcare professionals additional clinical guidelines and best practice recommendations. This can contribute to improving patient treatment outcomes and reducing potential complications.\u003c/p\u003e\n\u003cp\u003eAccidental ingestion or aspiration of foreign bodies is a common medical emergency that can pose a threat to the health of patients.By determining the most effective tools, we can better ensure patient safety and reduce unnecessary risks. Knowing which tool is more effective can also assist healthcare institutions in more efficiently allocating resources, enhancing the efficiency of medical services, lowering costs, and ensuring that patients receive high-quality care.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003e2.1 General\u0026nbsp;Information\u003c/p\u003e\n\u003cp\u003eThis study included a total of 143 patients with confirmed upper gastrointestinal foreign bodies, among\u0026nbsp;whom\u0026nbsp;there were 62 male and 81 female patients, ranging in age from 4 to 85 years (mean age of 44.4 \u0026plusmn; 17.5 years).\u0026nbsp;A total of 127 cases of foreign body impaction were successfully removed, with 45 cases (35.43%) using serrated biopsy forceps and 82 cases (64.57%) using foreign body forceps. There were 16 cases of unsuccessful removal, with 3 cases (18.75%) using serrated biopsy forceps and 13 cases (81.25%) using foreign body forceps.\u003c/p\u003e\n\u003cp\u003e2.2 Equipment\u0026nbsp;and Materials\u003c/p\u003e\n\u003cp\u003e2.2.1 Medical\u0026nbsp;devices\u003c/p\u003e\n\u003cp\u003eGastroscopes: Olympus Corporation,\u0026nbsp;Japan (including models GIF-H260, GIF-H260Z, GIF-Q260J, GIF-H290).\u003c/p\u003e\n\u003cp\u003eSerrated biopsy forceps: Boston Scientific Corporation.\u003c/p\u003e\n\u003cp\u003eForeign body forceps:\u0026nbsp;Olympus Corporation,\u0026nbsp;Japan; ENDO-FLEX Corporation, Germany.\u003c/p\u003e\n\u003cp\u003eTransparent cap:\u0026nbsp;Olympus Corporation,\u0026nbsp;Japan.\u003c/p\u003e\n\u003cp\u003e2.2.2 Medications\u003c/p\u003e\n\u003cp\u003eLidocaine Gel: Manufactured by Xinyu Boyuan Biochemical Medical Supplies Co., Ltd., and Handan Kangye Pharmaceutical Co., Ltd.\u003c/p\u003e\n\u003cp\u003e2.3 Methods\u003c/p\u003e\n\u003cp\u003e2.3.1 Nursing cooperation\u003c/p\u003e\n\u003cp\u003ePrior to the procedure, nurses prepared the appropriate endoscopic equipment and surgical accessories based on factors such as the type, nature, and size of the foreign body, as well as the physician\u0026apos;s preferred techniques. When necessary, a transparent cap was attached to the distal end of the endoscope to aid in foreign body retrieval and to protect the esophageal mucosa.\u0026nbsp;Patients\u0026nbsp;undergoing local anesthesia were asked to hold 5-7 ml of lidocaine gel in their mouth and swallow it after 5 minutes.\u003c/p\u003e\n\u003cp\u003eAssisting the patient to assume a left lateral position[8], removing any removable dentures, having the patient bite on a dental pad, and guiding them to maintain relaxation and avoid tension were considered essential for ensuring smooth collaboration between the patient and the physician. Upon discovering a foreign body, selecting the appropriate foreign body forceps or serrated biopsy forceps based on the characteristics of the foreign body, adjusting to the optimal angle, and facilitating the smooth removal of the foreign body along with the endoscope were crucial steps. To minimize damage to the gastric and esophageal mucosa from sharp foreign bodies, special attention was given during the foreign body removal process. When the foreign body was located in the upper esophagus or pharyngeal area, it was vital to securely grip the foreign body to prevent it from becoming loose, thereby avoiding the risk of the foreign body entering the trachea and causing injury, asphyxiation, or the danger of airway obstruction. Throughout the surgical procedure, close monitoring of the patient\u0026apos;s vital signs and changes in their medical condition was imperative[9].\u003c/p\u003e\n\u003cp\u003e2.3.2 Postoperative Care\u003c/p\u003e\n\u003cp\u003eAfter the procedure, the physician\u0026nbsp;used\u0026nbsp;the endoscope again to observe whether there\u0026nbsp;was\u0026nbsp;any damage to the mucosa.\u0026nbsp;In\u0026nbsp;the\u0026nbsp;case of bleeding, local application of epinephrine or clotting enzyme was used for hemostasis[9].\u0026nbsp;Patients were advised to consume warm and liquid food within two hours after the surgery, and if no adverse reactions such as coughing occur, they were allowed to proceed to a semiliquid diet.\u0026nbsp;Within 24 hours after the surgery, close observation was carried out to detect the occurrence of complications such as subcutaneous emphysema and gastrointestinal bleeding.\u0026nbsp;Additionally, patients were informed about the importance of seeking timely medical attention if any complications arose.\u0026nbsp;For individuals with self-harming tendencies, psychological\u0026nbsp;counseling\u0026nbsp;and health guidance were provided[9].\u003c/p\u003e\n\u003cp\u003e2.3.3 Admission Criteria\u003c/p\u003e\n\u003cp\u003eThe endoscopic reports and images encompassed essential patient details such as the name, sex, age, type of foreign body, category, and location of impaction. Additionally, they included pertinent information about the accessories employed for foreign body removal and descriptions of any complications arising from the removal procedure.\u003c/p\u003e\n\u003cp\u003e2.3.4 Data analysis\u003c/p\u003e\n\u003cp\u003eThe 143 cases of upper gastrointestinal foreign bodies were categorized into the serrated biopsy forceps group (48 cases) and the foreign body forceps group (95 cases) based on the types of endoscopic accessories used. Among these two groups, a total of 127 cases with successfully removed foreign bodies were selected. According to the information in the endoscopic reports, the patients with foreign body impaction were divided into three age groups: children (below 14 years), young and middle-aged adults (14-59 years), and elderly individuals (60 years and above), aiming to analyze the age and\u0026nbsp;sex\u0026nbsp;distribution of successfully removed foreign bodies using serrated biopsy forceps and foreign body forceps. Additionally, the occurrences of different foreign body impaction sites (pharynx, upper esophagus, middle esophagus, lower esophagus, and stomach) were recorded and analyzed.\u0026nbsp;The\u0026nbsp;chi-square test was utilized to calculate and verify whether there were differences in the effectiveness of the two forceps in extracting foreign bodies from different locations. Based on the various categories of foreign bodies, they were classified as fish bones, poultry bones, other fragmented bones (from pigs, cows, sheep, frogs, etc.), fruit pits, and other categories (food masses, toothpicks, metals, dentures, and pen caps). Furthermore, these foreign bodies were categorized based on their shapes into fine needle-like, flat piece-like, irregular-shaped, and other types (spindle-shaped, food masses, elongated blunt shapes, and rounded blunt shapes). The same statistical approach was employed to compare whether there were differences in the effectiveness of the two forceps in extracting foreign bodies of different categories and shapes. Complications arising from endoscopic procedures were recorded and analyzed to compare the safety of the two forceps. Moreover, we reviewed the intraoperative descriptions of the 16 cases of unsuccessful removal from both groups to analyze the reasons for the failures.\u003c/p\u003e\n\u003cp\u003e2.4 Ethical-considerations\u003c/p\u003e\n\u003cp\u003eThis study has been approved by the Ethics Committee for Human Research at the Fourth Affiliated Hospital of Zhejiang University School of Medicine.(Approval NO.K2023110).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e3.1 Comparison of Successfully Removed Foreign Bodies between the Two Groups\u003c/p\u003e\n\u003cp\u003eA total of 127 cases with successfully removed foreign bodies were analyzed. Table 1 presents the sex distribution in the serrated biopsy forceps group and foreign body forceps group, with a slightly higher prevalence of females in both groups. In the serrated biopsy forceps group, no cases were reported for children (below 14 years old), with the cases predominantly comprising middle-aged individuals (14-59 years), while cases involving elderly adults (60 years and above) were relatively few. Similarly, in the\u0026nbsp;foreign body forceps\u0026nbsp;group, middle-aged cases were the most prevalent, followed by a relatively higher proportion of elderly cases compared to the\u0026nbsp;biopsy forceps\u0026nbsp;group. Additionally, a small number of pediatric cases (below 14 years old) were observed in the foreign body forceps group, as depicted in Table 1.\u003c/p\u003e\n\u003cp\u003eIn the reports of successful removal in the serrated biopsy forceps group and the foreign body forceps group, there was minimal difference in the number of cases located in the pharynx, middle esophagus, and lower esophagus. However, for cases located in the upper esophagus, the foreign body forceps group exhibited a higher count than the serrated biopsy forceps group,\u0026nbsp;although\u0026nbsp;this difference lacked statistical significance between the two groups (P\u0026gt;0.05), as shown in Table 2.\u003c/p\u003e\n\u003cp\u003eThe number of successfully removed fish bones did not significantly differ between the two groups. However, in the foreign body forceps group, there were more successfully removed foreign bodies of categories such as poultry bones, other fragmented bones (from pig, cow, sheep, frog, etc.), fruit pits, and other types (food masses, toothpicks, metal objects, dentures, pen caps, etc.), compared to the serrated biopsy forceps group. This difference between the two groups was statistically significant (P\u0026lt;0.05), as shown in Table 2.\u003c/p\u003e\n\u003cp\u003eIn this study, the foreign bodies were categorized into four types based on their different shapes. Among the fine needle-shaped foreign bodies, fish bones were the most common, with comparable numbers of successfully removed cases in both groups. Among flat-shaped foreign bodies, poultry bones were the most prevalent, followed by other fragmented bones (from\u0026nbsp;pigs,\u0026nbsp;cows, sheep,\u0026nbsp;frogs, etc.), with fish bones being relatively less common. In this category, the serrated biopsy forceps group had significantly fewer successful removals compared to the foreign body forceps group, as shown in Tables 2 and 3.\u003c/p\u003e\n\u003cp\u003eIrregular-shaped foreign bodies were less common, and they were often associated with fish bones and other fragmented bones (from\u0026nbsp;pigs,\u0026nbsp;cows, sheep,\u0026nbsp;frogs, etc.). The numbers of these foreign bodies were similar between the two groups. Other types of foreign bodies (such as spindle-shaped, lumpy, elongated, and rounded) were commonly found in fruit pits and other miscellaneous items (food masses, toothpicks, metal objects, dentures, pen caps, etc.). Interestingly, the serrated biopsy forceps group had no cases of this type, while the foreign body forceps group successfully removed 17 cases. This difference between the two groups was statistically significant (P\u0026lt;0.05), as shown in Tables 2 and 3.\u003c/p\u003e\n\u003cp\u003eIn the group where serrated biopsy forceps were used for successful foreign body removal, there were no cases of mucosal injury. In the group where foreign body forceps were used, there were 5 cases of mucosal injury, as shown in Table 4.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.2 Results of Failed Foreign Body Removal\u003c/p\u003e\n\u003cp\u003eIn this study, within the group using serrated forceps, there were 3 cases of failed foreign body retrieval, all of which involved thin needle-like fish bones (Table 5 and Table 6). Among these cases, 2 failures were attributed to patients experiencing nausea and vomiting during the procedure, and 1 case resulted from the slipping of a thin needle-like fish bone during retrieval attempts.\u003c/p\u003e\n\u003cp\u003eIn the group using foreign body forceps, there were a total of 13 cases of unsuccessful foreign body retrieval. Fish bones and other fragmented bones (such as from pigs, cows, sheep, frogs, etc.) were the most commonly encountered types of foreign bodies in these failures. Additionally, there were a few cases involving poultry bones and other objects (such as food masses, toothpicks, metal objects, dentures, and pen caps). Among the different types of foreign bodies, flat fragments were the most prevalent, followed by thin needle-like shapes and irregular shapes, while other types (spindle-shaped, clumps, blunt long shapes, round blunt shapes, etc.) were less common (Table 5 and Table 6). Among the 13 cases of retrieval failures, 7 were attributed to patients experiencing nausea and vomiting, which hindered the retrieval process. Three cases resulted from the brittleness of the foreign body, causing it to break during retrieval attempts. Two cases involved the foreign body slipping from the forceps, and in 1 case, the foreign body was too large for successful retrieval.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUnlike previous reports where the proportion of males was higher than\u0026nbsp;that of\u0026nbsp;females[7,10], the results of this study showed a different trend. Among the patients with upper gastrointestinal foreign bodies, there were 71 females (55.91%) and 56 males (44.09%). This discrepancy could be attributed to the exclusion of incomplete reports during the data collection process.\u003c/p\u003e\n\u003cp\u003eThe management guidelines for ingested foreign bodies in the United States indicate that most cases occur in the pediatric population, with the highest incidence observed among children aged 6 months to 6 years. Among adults, genuine instances of foreign body ingestion often occur in individuals with mental disorders, intellectual disabilities, or alcohol-induced impairments, or in individuals seeking secondary gains through medical facilities. Cases involving the ingestion of multiple foreign bodies and recurrent incidents are not uncommon. Additionally, toothless adults, including those with dentures, face a higher risk of foreign body ingestion[6].\u003c/p\u003e\n\u003cp\u003eIn our study data, the highest proportion of patients were in the middle-aged to young-adult group (14-59 years), accounting for 76.38% of cases. The elderly group (60 years and above) followed, while the pediatric group (below 14 years) had the lowest representation at 1.57%. This distribution might be correlated with the fact that the study was conducted in a comprehensive adult hospital setting.\u003c/p\u003e\n\u003cp\u003eThere are four potential\u0026nbsp;anatomically\u0026nbsp;narrow regions in the esophagus that may be affected by foreign bodies, including the upper esophageal sphincter, aortic arch level, tracheobronchial crossing, lower esophageal sphincter, and gastroesophageal junction. Notably, the most pronounced narrowing occurs at the cricopharyngeus muscle at the entrance of the esophagus, which contributes to the higher incidence of foreign body impaction[11]. In our study, both the group treated with serrated biopsy forceps and the group treated with foreign body forceps underwent successful removal of foreign bodies primarily located in the upper esophagus, consistent with previous reports[12-13]. Both serrated biopsy forceps and foreign body forceps can freely open and close when removing foreign bodies from different positions in the upper digestive tract, and there was no significant difference in the statistical analysis of the data between the two groups.\u003c/p\u003e\n\u003cp\u003eThe Zhejiang region boasts a well-developed fishing industry, and fish are a common staple in the daily diet of its residents. Local people tend to consume fish without removing the bones, resulting in bones being mixed with meat and soup. This practice increases the likelihood of fish bone ingestion[14]. In our study, fish bones were also the most frequently lodged foreign bodies. The numbers of successful and failed removal cases were relatively similar between the serrated biopsy forceps group and the foreign body forceps group\u0026nbsp;regarding\u0026nbsp;the extraction of fish bones. Hence, both serrated biopsy forceps and foreign body forceps exhibited comparable efficacy in removing fish bones.\u003c/p\u003e\n\u003cp\u003eRegarding categories such as poultry bones, other fragmented bones (pork, beef, lamb, frog, etc.), fruit pits, and other objects (food clusters, toothpicks, metal, dentures, pen caps, etc.), there were significant differences in the quantities extracted between the serrated biopsy forceps group and the foreign body forceps group. These types of foreign bodies often have larger sizes or harder textures. Foreign body forceps excel in terms of their wider opening size and gripping force, making them more effective for extracting such larger or harder foreign bodies. This finding aligns with previous reports[6,7,15,16].\u003c/p\u003e\n\u003cp\u003eConcerning different types of foreign bodies, there were distinct differences between the\u0026nbsp;serrated biopsy forceps\u0026nbsp;group and the foreign body forceps group. For needle-like foreign bodies, both groups had similar successful extraction rates. However, for flat-shaped foreign bodies, the friction against the esophageal wall increases with the size of the foreign body, making it more challenging to remove. Therefore, foreign body forceps were preferred for extracting these larger foreign bodies. Moreover, when dealing with other types of foreign bodies (spindle-shaped, food clusters, blunt long shapes, rounded blunt shapes), foreign body forceps were also predominantly used. These types of foreign bodies are commonly associated with fruit pits, food clusters, toothpicks, metal, dentures, and pen caps, making foreign body forceps a more effective choice than\u0026nbsp;serrated biopsy forceps.\u003c/p\u003e\n\u003cp\u003eAmong the 127 successfully removed upper digestive tract foreign bodies in this study, only 5 cases that were extracted using foreign body forceps exhibited mucosal injuries. This phenomenon can be attributed to the larger size of the foreign bodies typically removed with foreign body forceps, leading to more intense patient reactions during the procedure. To address this issue, preoperative evaluation of the foreign body\u0026apos;s size should be conducted, and the use of an endoscopic transparent cap should be considered in advance. The transparent cap serves to widen narrow physiological areas, providing clearer visibility of the impacted foreign body and creating a larger operational space for its extraction. This measure safeguards the esophageal mucosa from sharp foreign body-induced injuries during the extraction process[17].\u003c/p\u003e\n\u003cp\u003eThe extraction of upper digestive tract foreign bodies requires a high level of patient cooperation during the procedure. In this study, almost half of the 16 cases of failure were attributed to patients experiencing nausea and vomiting during the procedure. Reports indicate[17,18] that some higher-risk cases with challenging foreign body removal or younger pediatric patients may necessitate the use of intravenous sedation or general anesthesia. This approach ensures the successful completion of the procedure and minimizes complications arising from patient discomfort or involuntary movements.\u003c/p\u003e\n\u003cp\u003eThis study exclusively included non-painless cases from our hospital and excluded some cases with incomplete information in the doctors\u0026apos; reports during data collection. Therefore, this study has limitations, including a wide sampling time span and a relatively small sample size.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFlexible endoscopic serrated biopsy forceps are effective for the retrieval of small and slender flat foreign objects such as fish bones and poultry bones from the upper gastrointestinal tract. In comparison to foreign body forceps, serrated biopsy forceps have lower costs, greater flexibility in usage, and no significant differences in operation-related complications. Therefore, when extracting small and slender flat foreign objects, serrated biopsy forceps are considered the primary choice.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003eThis article is an original research work and has not been previously published or submitted to other journals. All materials and viewpoints cited in this article have been appropriately referenced and sourced. The authors acknowledge and fully respect the research and contributions of others, and have not engaged in plagiarism or infringed upon the intellectual property of others.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Funding\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Disclosures\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDrs. Hanfeng Lv,Linzhen Zhu and Heng Yang,have no conflicts of interest or financial ties to disclose.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Data availability statement\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Acknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eYoo DR, Im CB, Jun BG, et al. Clinical outcomes of endoscopic removal of foreign bodies from the upper gastrointestinal tract. BMC Gastroenterol. 2021;21(1):385. Published 2021 Oct 19. DOI:10.1186/s12876-021-01959-3\u003c/li\u003e\n\u003cli\u003eLin, C., Lin, Q., \u0026amp; Zheng, W. Epidemiological Investigation of Gastrointestinal Foreign Bodies Over Ten Years and Analysis of Factors Affecting Complications [J]. Chinese Journal of Endoscopy,2023, 29(09), 49-56.\u003c/li\u003e\n\u003cli\u003eChoe JY, Choe BH. Foreign Body Removal in Children Using Foley Catheter or Magnet Tube from Gastrointestinal Tract. Pediatr Gastroenterol Hepatol Nutr. 2019;22(2):132-141. doi:10.5223/pghn.2019.22.2.132\u003c/li\u003e\n\u003cli\u003eBirk M, Bauerfeind P, Deprez PH, H\u0026auml;fner M, Hartmann D, Hassan C, Hucl T, Lesur G, Aabakken L, Meining A. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy （ESGE） Clinical Guideline. Endoscopy. 2016 May;48（5）:489-96. doi: 10.1055/s-0042-100456. \u003c/li\u003e\n\u003cli\u003eMosca S, Manes G, Martino R, et al.. Endoscopic management of foreign bodies in the upper gastrointestinal tract: report on a series of 414 adult patients. Endoscopy. 2001 Aug;33(8):692-6.doi: 10.1055/s-2001-16212\u003c/li\u003e\n\u003cli\u003eEisen GM, Baron TH, Dominitz JA, et al. Guideline for the management of ingested foreign bodies. Gastrointest Endosc. 2002 Jun;55(7):802-6.doi:10.1016/s0016-5107(02)70 407-0\u003c/li\u003e\n\u003cli\u003eLi ZS, Sun ZX, Zou DW, et al. Endoscopic management of foreign bodies in the upper-GI tract: experience with 1088 cases in China. Gastrointest Endosc. 2006 Oct;64(4):485-92.doi: 10.1016/j.gie.2006.01.059\u003c/li\u003e\n\u003cli\u003eGinsberg GG. Management of ingested foreign objects and food bolus impactions. Gastrointest Endosc. 1995 Jan;41(1):33-8. doi: 10.1016/s0016-5107(95)70273-3\u003c/li\u003e\n\u003cli\u003eFei X,Zhao K. [Experience in the Endoscopic Retrieval of Upper Gastrointestinal Foreign Bodies in 30 Cases]. Shandong Medical Journal, 2008, 48(37): 27.Chinese.\u003c/li\u003e\n\u003cli\u003eChinese Enterprise Management Research Association Institute of Public Health and Medical Health Management. [Expert Consensus on Emergency Management of Adult Esophageal Foreign Bodies (2020 Edition)]. Chinese Journal of Emergency Medicine, 2021, 30(01): 25-30.Chinese.\u003c/li\u003e\n\u003cli\u003eYang Y, Yu A, Xie Z, et al.[Clinical Characteristics of Impacted Upper Gastrointestinal Foreign Bodies and Analysis of Risk Factors for Complications]. West China Medical Journal, 2022, 37(11): 1630-1635.Chinese.\u003c/li\u003e\n\u003cli\u003eLee CY, Kao BZ, Wu CS, et al. Retrospective analysis of endoscopic management of foreign bodies in the upper gastrointestinal tract of adults. J Chin Med Assoc.2019;82 (2):105-109. doi:10.1097/JCMA.0000000000000010\u003c/li\u003e\n\u003cli\u003eGarcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology, 2017, 65(1):310-335.doi:10.1002/ hep.28906\u003c/li\u003e\n\u003cli\u003eYao CC, Wu IT, Lu LS, et al. Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract of Adults. Biomed ResInt.2015; 2015:658602. doi:10.1155/2015/658 602\u003c/li\u003e\n\u003cli\u003eZhang S, Cui Y, Gong X, et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract in South China: a retrospective study of 561 cases. Dig Dis Sci. 2010;55(5):1305-1312. doi:10.1007/s10620-009-0900-7\u003c/li\u003e\n\u003cli\u003eGuo C, Wu J, He H, et al. Evaluation of the medical economics and safety: two methods for the endoscopic removal of jujube pits. Rev Esp Enferm Dig. 2019;111(3):209-213. doi:10.17235/reed.2018.5794/2018\u003c/li\u003e\n\u003cli\u003eYuan, F, Gong W, et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract: An analysis of 846 cases in China. Experimental and therapeutic medicine vol. 15,2 (2018): 1257-1262. doi:10.3892/etm.2017.5561\u003c/li\u003e\n\u003cli\u003ePang Q, Quan X, Zhu L, et al. [Cooperative Techniques and Nursing Care for Endoscopic Forceps Removal of Pediatric Upper Gastrointestinal Foreign Bodies]. Guizhou Medical Journal, 2013, 37(10): 955-956.Chinese.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Distribution of Successfully Removed Foreign Body Patients by Sex\u0026nbsp;and\u0026nbsp;Age\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.797919762258545%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48.14264487369985%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTypes of Forceps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.059435364041605%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTotal [Cases (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52%\" valign=\"bottom\"\u003e\n \u003cp\u003eSerrated Biopsy Forceps Group/[Cases (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48%\" valign=\"bottom\"\u003e\n \u003cp\u003eForeign Body Forceps Group/[Cases (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.166172106824925%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.584569732937684%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.07418397626113%\" valign=\"top\"\u003e\n \u003cp\u003e19（42.22）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.14540059347181%\" valign=\"top\"\u003e\n \u003cp\u003e37（45.12）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.02967359050445%\" valign=\"top\"\u003e\n \u003cp\u003e56（44.09）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.2972972972973%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.5472972972973%\" valign=\"top\"\u003e\n \u003cp\u003e26（57.78）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.35135135135135%\" valign=\"top\"\u003e\n \u003cp\u003e45（54.88）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.804054054054053%\" valign=\"top\"\u003e\n \u003cp\u003e71（55.91）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.166172106824925%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.584569732937684%\" valign=\"top\"\u003e\n \u003cp\u003eChildren (below 14 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.07418397626113%\" valign=\"top\"\u003e\n \u003cp\u003e0（0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.14540059347181%\" valign=\"top\"\u003e\n \u003cp\u003e2（2.44）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.02967359050445%\" valign=\"top\"\u003e\n \u003cp\u003e2（1.57）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.2972972972973%\" valign=\"top\"\u003e\n \u003cp\u003eYoung and middle-aged adults (14-59 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.5472972972973%\" valign=\"top\"\u003e\n \u003cp\u003e41（91.11）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.35135135135135%\" valign=\"top\"\u003e\n \u003cp\u003e56（68.29）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.804054054054053%\" valign=\"top\"\u003e\n \u003cp\u003e97（76.38）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.2972972972973%\" valign=\"top\"\u003e\n \u003cp\u003eElderly adults (60 years and above)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.5472972972973%\" valign=\"top\"\u003e\n \u003cp\u003e4（8.89）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.35135135135135%\" valign=\"top\"\u003e\n \u003cp\u003e24（29.27）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.804054054054053%\" valign=\"top\"\u003e\n \u003cp\u003e28（22.05）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.75074183976261%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.07418397626113%\" valign=\"top\"\u003e\n \u003cp\u003e45（35.43）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.14540059347181%\" valign=\"top\"\u003e\n \u003cp\u003e82（64.57）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.02967359050445%\" valign=\"top\"\u003e\n \u003cp\u003e127（100）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2. Chi-Square Test for Comparison of Successfully Removed Foreign Bodies between the Serrated Biopsy Forceps and Foreign Body Forceps Groups\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" style=\"margin-right: calc(0%); width: 100%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.779761904761905%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.18452380952381%\" colspan=\"2\"\u003e\n \u003cp\u003eTypes of Forceps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.517857142857142%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.517857142857142%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eSerrated Biopsy Forceps Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eForeign Body Forceps Group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.617210682492583%\"\u003e\n \u003cp\u003eImpaction Location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.2106824925816%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.617210682492583%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.617210682492583%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.468842729970326%\" rowspan=\"6\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.230\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.468842729970326%\" rowspan=\"6\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.778761061946902%\" rowspan=\"5\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.663716814159294%\"\u003e\n \u003cp\u003ePharynx\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.778761061946902%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.778761061946902%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.11764705882353%\"\u003e\n \u003cp\u003eUpper esophagus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.11764705882353%\"\u003e\n \u003cp\u003eMiddle esophagus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.11764705882353%\"\u003e\n \u003cp\u003eLower esophagus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.11764705882353%\"\u003e\n \u003cp\u003eStomach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.617210682492583%\"\u003e\n \u003cp\u003e\u0026nbsp;Foreign Body Category\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.2106824925816%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.617210682492583%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.617210682492583%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.468842729970326%\" rowspan=\"6\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18.547\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.468842729970326%\" rowspan=\"6\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.778761061946902%\" rowspan=\"5\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.663716814159294%\"\u003e\n \u003cp\u003eFish bones\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.778761061946902%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.778761061946902%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.11764705882353%\"\u003e\n \u003cp\u003ePoultry bones\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.11764705882353%\"\u003e\n \u003cp\u003eOther fragmented bones (from a pig, cow, sheep, frog, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.11764705882353%\"\u003e\n \u003cp\u003eFruit pits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.11764705882353%\"\u003e\n \u003cp\u003eOther Categories (food bolus, toothpick, metal objects, dentures, pen caps, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.617210682492583%\"\u003e\n \u003cp\u003eForeign Body Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.2106824925816%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.617210682492583%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.617210682492583%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.468842729970326%\" rowspan=\"5\"\u003e\n \u003cp\u003e13.658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.468842729970326%\" rowspan=\"5\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.778761061946902%\" rowspan=\"4\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.663716814159294%\"\u003e\n \u003cp\u003eNeedle-Like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.778761061946902%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.778761061946902%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.11764705882353%\"\u003e\n \u003cp\u003eFlat-Shaped\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.11764705882353%\"\u003e\n \u003cp\u003eIrregular Shapes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.11764705882353%\"\u003e\n \u003cp\u003eOther Types (Spindle-Shaped, Food Bolus, Long Blunt, Rounded Blunt, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.94117647058823%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3. Cross-Tabulation of Successfully Removed Foreign Body Types and Categories\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.974739970282318%\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62.704309063893014%\" colspan=\"5\"\u003e\n \u003cp\u003eForeign Body Category\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.320950965824666%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.48341232227488%\"\u003e\n \u003cp\u003eFish bones\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.48341232227488%\"\u003e\n \u003cp\u003ePoultry bones\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.90521327014218%\"\u003e\n \u003cp\u003eOther fragmented bones (from pig, cow, sheep, frog, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.246445497630333%\"\u003e\n \u003cp\u003eFruit pits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.881516587677726%\"\u003e\n \u003cp\u003eOther Categories (food bolus, toothpick, metal objects, dentures, pen caps, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.869436201780415%\" rowspan=\"4\"\u003e\n \u003cp\u003eForeign Body Type\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.2106824925816%\"\u003e\n \u003cp\u003eNeedle-Like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.572700296735905%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.572700296735905%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.462908011869436%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.42433234421365%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.578635014836795%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.308605341246292%\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.52861952861953%\"\u003e\n \u003cp\u003eFlat-Shaped\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.131313131313131%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.131313131313131%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.141414141414142%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.67676767676768%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.427609427609427%\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.52861952861953%\"\u003e\n \u003cp\u003eIrregular Shapes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.131313131313131%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.131313131313131%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.141414141414142%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.67676767676768%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.427609427609427%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.52861952861953%\"\u003e\n \u003cp\u003eOther Types (Spindle-Shaped, Food Bolus, Long Blunt, Rounded Blunt, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.131313131313131%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.131313131313131%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.141414141414142%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.67676767676768%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.427609427609427%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.974739970282318%\" colspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.589895988112927%\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.589895988112927%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.481426448736999%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.441307578008916%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.601783060921248%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.320950965824666%\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4. Cross-tabulation of Mucosal Injury in Patients with Successful Foreign Body Removal by Type of Forceps Used\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.9702823179792%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.9702823179792%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eTypes of Forceps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.059435364041605%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eSerrated Biopsy Forceps Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eForeign Body Forceps Group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMucosal Injury\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.910979228486646%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.02967359050445%\" valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.02967359050445%\" valign=\"top\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.02967359050445%\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5. Cross-Tabulation of Failed Foreign Body Categories and Forceps Types\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.9702823179792%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.9702823179792%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eTypes of Forceps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.059435364041605%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eSerrated Biopsy Forceps Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eForeign Body Forceps Group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Foreign Body Category\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003eFish bones\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003ePoultry bones\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eOther fragmented bones (from a pig, cow, sheep, frog, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003efruit pits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eOther categories (food bolus, toothpick, metal objects, dentures, pen caps, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.910979228486646%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.02967359050445%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.02967359050445%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.02967359050445%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 6. Cross Table of Failed Extraction: Type of Foreign Object and Type of Forceps\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.9702823179792%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.9702823179792%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eTypes of Forceps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.059435364041605%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eSerrated Biopsy Forceps Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eForeign Body Forceps Group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003eNeedle-Like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eFlat-Shaped\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eIrregular Shapes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eOther Types (Spindle-Shaped, Food Bolus, Long Blunt, Rounded Blunt, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.910979228486646%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.02967359050445%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.02967359050445%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.02967359050445%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Upper gastrointestinal, foreign body, biopsy forceps, foreign body retrieval forceps, retrospective analysis","lastPublishedDoi":"10.21203/rs.3.rs-4276777/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4276777/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective: This study aimed to compare the performance and safety of two types of endoscopic instruments, serrated biopsy forceps and foreign body retrieval forceps, for removing upper gastrointestinal foreign bodies.\u003c/p\u003e\n\u003cp\u003eMaterials and Methods: We conducted a retrospective analysis of 143 cases from January 1, 2016, to December 1, 2022. Patients were divided into two groups based on the instruments used: serrated biopsy forceps (48 cases) and foreign body retrieval forceps (95 cases). We collected data on patient demographics, retrieval success rates, postoperative complications, and characteristics of the foreign bodies. Statistical analysis was performed using SPSS software version 26.0 (IBM Corp., Armonk, NY, USA).\u003c/p\u003e\n\u003cp\u003eResults: In the 143 cases, the serrated biopsy forceps group had 45 successful retrievals and 3 failures, while the foreign body retrieval forceps group had 82 successful retrievals and 13 failures. There were significant differences in the types and categories of successfully retrieved foreign bodies between the two groups (P\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eConclusion: Flexible endoscopic serrated biopsy forceps are effective for extracting elongated and small flat foreign bodies such as fish bones and poultry bones in the upper gastrointestinal tract. Due to their advantages in terms of cost and flexibility, serrated biopsy forceps can be given priority when considering the removal of such foreign bodies.\u003c/p\u003e","manuscriptTitle":"Treatment of Upper Gastrointestinal Foreign Bodies with Different Endoscopic Instruments: A Retrospective Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-29 12:20:09","doi":"10.21203/rs.3.rs-4276777/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6d4f591b-40f9-4c87-822e-f8ec99d831b2","owner":[],"postedDate":"April 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-29T12:20:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-29 12:20:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4276777","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4276777","identity":"rs-4276777","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}