Endoscopic removal of a chicken bone embedded in a child's esophagus (with video).

Competing Interests: Disclosure Supported by 1·3·5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (ZYJC21011), and National Nature Science Foundation of China (82170675). All authors disclosed no financial relationships. Commentary Retained foreign body in the esophagus is a GI emergency that requires prompt endoscopic evaluation and treatment with early removal of the foreign object. Long-standing foreign bodies may damage the integrity of the esophageal wall, leading to acute perforation, mediastinitis, and fistulas to the adjacent structures. The early asymptomatic period of unwitnessed ingestion and the presence of nonspecific symptoms cause delay in diagnosis and treatment in infants and toddlers. They usually present with refusal to eat, drooling, dysphagia, or respiratory symptoms. Neck swelling, crepitus, and pneumomediastinum are common findings of a perforation caused by foreign body impaction. The authors present an unfortunate case of esophageal perforation as a result of prolonged retention of a sharp object in the esophagus, signifying the need for urgent endoscopy to prevent or treat a resulting adverse event. Interestingly, the authors used an unconventional approach to treating esophageal perforation caused by a migrated foreign bone fragment, with controlled expansion of the perforation and removal of the fragment. The perforation resolved with antibiotics and placement of a nasogastric tube, signifying the capacity of mucosal healing in pediatric patients, where stent or clip closure may be difficult because of the size of the esophagus and the irregular shape of the perforation. By implementing this novel approach, the authors successfully treated a major adverse event and prevented further, more invasive treatments. Mihajlo Gjeorgjievski, MD, Gastroenterology Piedmont Hospital, Atlanta, Georgia, USA Amy Tyberg, MD, FASGE, FACG, Associate Editor for Focal Points