Device choice and experience level in endoscopic foreign object retrieval: An in vivo study

Foreign object retrieval is technically demanding. Success may depend upon device choice and the experience level of the endoscopist, although these factors have not been systematically evaluated in an in vivo model. In anesthetized male adult pigs, the ability to retrieve foreign objects (metal tack (12 mm disc, 10 mm spike), button disc battery (12 mm), wooden toothpick (67mm)) placed endoscopically into the stomach was assessed. Five Clinical GI attending physicians, 2 Basic Science Research (BSR) attendings, and 4 fellows-in-training participated. The devices used were the Roth Retrieval Net (US Endoscopy), Rat Tooth forcep (Olympus), Dormia basket (Olympus), Polypectomy Snare (Microvasive) and Radial Jaw forcep (Microvasive). Endoscopy was performed with Olympus Evis GIF-100. The time to retrieve the objects into an esophageal overtube within a 5 minute maximum was measured. Results: Only the Roth Net and Dormia basket were successful in retrieving the button disc battery, although the Roth Net was superior (100% vs 27%, Fisher p<0.025). All devices were equally successful at retrieving the tack (82-100%, p=NS), although the snare was significantly faster than the Roth Net (2 tailed t-test p<0.05) with a trend towards being faster than the Rat Tooth (p<0.07) and Radial Jaw forceps (p<0.09). Additionally, for the tack there were significantly fewer difficulties encountered with the snare (1 LES injury) vs. Roth Net (6: 1 failure to grasp, 1 device failure, 3 dropped object after grasping, 1 inadequated control of sharp leading edge; Fisher p<0.03). The Roth net was incapable of retrieving the toothpick; the other devices were equally successful (91-100%). The Clinical attendings had a significantly higher success rate (95%) than the fellows (82%, Chi Square p<0.05) or combined fellows/BSR attendings (80%, p<0.02). The Clinical attendings were significantly faster (1.18 ± 0.17 min, mean ± SEM) than the fellows (2.39 ± 0.28 min, t-test p<0.0002) or the fellows/BSR attendings (2.25 ± 0.22 min, p<0.0003). Conclusions: 1. The Roth Net is the best device for retrieving smooth objects such as the button disc battery. 2. For sharp objects, such as the tack and toothpick, best results were achieved with the snare, although the forceps were also effective. 3. More experienced endoscopists had higher success rates and faster retrieval times. 4. Both device choice and the experience level of the endoscopist impact on successful foreign object retrieval.