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With foreign body impactions on the rise, gastroenterologists are increasingly challenged to come to the rescue with a safe extraction, but with preparation and utilization of key strategies, the alarming scenarios that may be feared can be safely avoided, experts say.

Research indicates that the incidence of foreign body ingestions has indeed been on the rise in recent decades, however, “the good news is that 80%-90% of these foreign bodies will pass on their own,” said Michelle Hughes, MD, an assistant professor in the Section of Digestive Diseases at the Yale School of Medicine, New Haven, Connecticut, in a presentation at Digestive Disease Week (DDW) 2026.

“About 10%-20% will require endoscopic removal, and about 1% will require help from a surgeon,” she added.

Among key indicators dictating which scenario is most likely are the size of the foreign body, itself, Hughes noted.

“If the object is greater than 2.5 cm wide or 6 cm in length, those are the [dimensions] in which objects can get stuck in the gastrointestinal tract,” she said.

Determining precisely where the object is located is another key initial step, and patient reported symptoms may or may not be reliable, Hughes noted.

“Patients can do a very good job of localizing the impaction above the cricopharyngeus,” she said. “Unfortunately, once the foreign object goes below the cricopharyngeus, patients are completely unable to localize the impaction, even if they think they can, so [their attempts to localize] should not be used to drive your clinical decision making too much,” Hughes said.

Imaging such as biplane x-ray or CT can be useful, however, even those modalities may fail to identify some objects, ranging from fish or chicken bones to wood, plastic, glass, or thin metal objects.

“Just because it’s not seen on imaging doesn’t mean it’s not necessarily there,” Hughes cautioned.

Timing Is a Critical Consideration 

While some foreign objects may not be as urgent, high-risk objects can represent ticking clocks and may pose a risk of progression to complete bowel obstructions, causing deep injury, perforation, or worse.

“This can be our biggest fear — you don’t want to leave things sitting in the GI tract too long,” Hughes warned, noting that patients should be counseled on those concerns if there is hesitation about endoscopy.

Guidelines from the European Society of Gastrointestinal Endoscopy (ESGE) describe items that should be treated with particular urgency, including button-shaped or disk, batteries, which can be highly corrosive and “[corrode] through the esophagus in a matter of hours,” Hughes noted.

Sharp or pointed objects, magnetic objects, or long objects that are unlikely to pass the duodenal sweep should also be considered urgent.

Of note, drug packets that have been ingested can be of substantial risk and attempts to remove them endoscopically are strongly discouraged. 

“These really should not be endoscopically removed, as the risk of rupture is very high and can potentially cause a catastrophic or terminal event for the patient,” Hughes said. “Those cases should be dealt with by a general surgeon.”

Preparation Is Key 

The importance of being prepared is especially essential when it comes to endoscopy for foreign body impaction, Hughes noted.

“Preparation may be the key to success, but it is really true when you’re dealing with endoscopy for foreign bodies,” she said. “We have a foreign body toolkit in our endoscopy unit, and I always make sure it is fully stocked.”

A good toolkit will have a wide variety of nets, snares, forceps, innovative suctioning devices, and a range of other grasping equipment, as well as tubes and scopes for the manipulation of stuck objects.

“Be creative when using endoscopy — crowdsource and ask endoscopy techs and nurses for suggestions,” Hughes said. 

Various new devices, such as distal scope attachments paired with snares, specialized graspers, are on the market, and are certainly worth considering, Hughes told Medscape Medical News. 

“However, you can also make a lot of similar setups with items stocked in your endoscopy unit,” she added.

“Because it is hard to tell what will work once you are looking at something endoscopically, don’t forget to try something, if you can, outside the patient first,” Hughes suggested. 

“This will help increase your likelihood of success and hopefully save you time in the end.”

Underlying Esophageal Disorders 

Importantly, as many as 54% of food impactions involve underlying esophageal disorders such as eosinophilic esophagitis (EoE), and rates of those cases have also been notably rising, with one study showing EoE-associated emergency department visits tripling between 2009 and 2019 and expected to further double by 2030. 

In more than half of those emergency department cases, patients have no prior diagnosis, and while the disorder is commonly initially identified upon presenting for the first time with a food impaction, more often than not, the EoE goes undiagnosed in such cases.

With only about a third of patients receiving biopsies at the index esophagogastroduodenoscopy (EGD), Hughes urged making sure to biopsy those patients.

“EoE is the most common cause of food impaction in adults less than 50 years old, yet less than half of those get biopsied at their index EGD, so [doing so] can spare them at least one in their series,” Hughes said. 

“This can also get them diagnosed and on appropriate treatment faster and hopefully reduce the risks for recurrent impactions or other complications such as structuring,” she noted.

Hughes underscored the need to consider the diagnosis even if there don’t appear to be clear signs. 

“About 10% or more patients will have a normal-appearing esophagus at the time you’re removing a food impaction,” she noted. “So, it’s important to consider biopsy, and to make sure to take both distal and proximal biopsies, according to guidelines.” 

“And if there remains no explanation, don’t forget to consider a workup for underlying dysmotility disorders which can be another cause of food impactions.”

Moderate Sedation or General Anesthesia? 

As reported in a position statement on sedation in gastrointestinal (GI) endoscopy, the ESGE notes that “currently, sedation and monitoring practices for GI endoscopy vary widely based on endoscopists’ and patients’ preferences, cultural attitudes, healthcare resource availability, local policies, and national legislation.”

While general anesthesia is increasingly being recommended in most cases, especially in esophageal food impactions and in cases where there is risk in having an unprotected airway, Hughes noted some exceptions in which moderate sedation may be either necessary due to circumstances or acceptable due to a lower level of risk. 

“The cohort that you can still [consider] moderate sedation in is the younger, cooperative, conversant patients who are able to participate,” she said. 

Importantly, other situations include those in which general anesthesia may not be available on demand overnight.

In such cases, “the question can be, do you wait many hours and let the patient potentially aspirate while waiting, or do you provide moderate sedation in a quicker fashion, and I think that you certainly have data on your side in terms of still doing a moderate sedation case at this point,” she said, referring to guidelines still deferring to local experience and situational variables. 

Commenting on the issue in the session, Mohammad Bilal, MD, an associate professor of medicine and director of Endoscopy in the Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, noted that evidence on the issue is lacking.

The argument that moderate sedation should not be used “logically makes sense,” but he argued that “with a food impaction that’s completely obstructed — you’re not just worried about aspirating, what you’re worried about is an impending perforation.”

In Colorado, “we get patients who did not have access to general anesthesia and then end up with a perforation and we’re having to do vacuum therapy and debridement, etc,” he said.

“If you have general anesthesia, that’s great, but if you don’t have access, that should not stop you from doing an endoscopy,” he said. “You just have to have an informed discussion with the patient and then make that decision.” 

Hughes agreed, noting “it is important for providers to keep in mind the evidence that does exist, especially around issues such as EoE that commonly come up when dealing with foreign bodies and food impaction.”

“In such cases, providers should then look to best practices and local experience and be sure to have robust discussions with their patients when evidence is lacking.” 

Hughes and Bilal had no disclosures to report. Bilal reported relationships with Boston Scientific, Steris Endoscopy, and Cook Medical.