Therapeutic strategy for removal of a large dental prosthesis with a sharp clasp, embedded in the esophagus.

theses, with sharp clasps which catch and stick in the esophagus, can lead to di− rect injury, compression ulcer, and per− foration or penetration [1,2]. To establish appropriate procedures for removing such objects according to our strategy for accidentally swallowed esophageal for− eign bodies, we examined: (i) the removal process in cases without esophageal re− section, and (ii) the resected specimen in a case where esophagectomy had been done. Our strategy for the management of esophageal foreign bodies is removal as follows: (i) nonsurgically, using a direct forceps or an endoscope, by direct verti− cal traction or horizontal rotation, and ex− tracting the foreign body or pushing it into the stomach; (ii) surgically, using synchronous direct manipulation under surgical exposure with the assistance of a forceps or an endoscope; or (iii) surgi− cally, with esophagotomy or esophagec− tomy. Endoscopic examination is done both pre− and post−removal; in nonsurgi− cal cases this is to check for any preceding injuries that might have been missed or for secondary injuries that occurred dur− ing removal of the foreign body, and in surgical cases it is to done to check for preceding injuries invisible from the op− erative field and to determine the method of reconstruction [3]. We encountered nine such cases in 6 years (involving the cervical esophagus in five cases and the thoracic in four). None of these dental prostheses with sharp clasps could be removed by simple vertical traction, but all except one could be removed by horizontal rotation (l" Fig. 1 and 2), the remaining one being removed by esophagectomy. Although post−removal endoscopy revealed ulcers in all cases, 1 or 2 days’ fasting was enough to prevent perforation or penetra− tion. In the resected specimen, we found longitudinal ulcers and perforation, indi− cating that the clasp had moved vertically at first, scratched the mucosa, and then rotated horizontally and penetrated the esophageal wall (l" Fig. 3 ±5) [3]. Although there have been many reports concerning procedures for passing for− eign bodies safely through the esophagus, there are few describing methods of ex− tracting a dental prosthesis with sharp clasps that are sticking into the esopha− geal wall [3 ± 5]. This study shows the im− portance of horizontal rotation for ex− tracting such a foreign body. Therapeutic strategy for removal of a large dental prosthesis with a sharp clasp, embedded in the esophagus