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November/December 2015 | tvpjournal.com eNDoscoPy esseNTiaLs 82 3. review all radiographs taken within the previous hour and examine the entire length of the Gi tract for evidence of additional foreign bodies, noting the number and general location of the objects. • Timeliness of radiography is crucial because, if gastric motility is normal, an object may move from the stomach into the small intestine between the time of the last radiograph and the procedure. • Therefore, a common, but avoidable, mistake during endoscopy is failure to locate a foreign body in the stomach because it has moved into the small intestine. • remember that endoscopic retrieval can only be reliably employed for objects in the esophagus and stomach; it is imperative to ensure there are no objects within the intestinal tract. Endoscopic Retrieval 1. Follow steps 1 and 2 from Esophageal Foreign Body Retrieval: Endoscopic Retrieval (page 80). 2. once the object has been found and characterized, select an instrument and advance it into the working channel. 3. Grasp the object frmly, then withdraw it to the endoscope tip, attempting to create favorable alignment between the object and endoscope to minimize resistance and facilitate smooth extraction through the Les and Ues. 4. retract the endoscope and object as a unit, slowly and without force. 5. During removal consider: • Deflecting the endoscope tip 30° to 40° to mimic the natural angle of the esophagus and stomach, if the object is difficult to remove through the Les • removing air from the stomach to create a less acute angle with the esophagus • Using an overtube to help distend the Les enough for the object to pass through. • Leaving an overtube in the stomach to facilitate more rapid removal of numerous foreign bodies because the operator can quickly slide the endoscope in and out of the patient. Additional Technique if the object is circular (eg, a prong collar) and diffcult to grasp, a suture technique may be helpful. This technique results in placement of a loop of suture through the foreign body, allowing the operator to remove the object by pulling both ends of the suture with gentle traction. 1. retract the grasping forceps through the working channel of the endoscope to grasp one end of a monoflament suture, while holding the free end of the suture outside the patient. 2. advance the forceps back into the tip of the endoscope and then the endoscope to the foreign body. 3. once at the desired location, advance the suture around or A d v a n c e d M o n i t o r s C O R P O R A T I O N Tele-View ® USB Endoscope/Gastroscope *Computer Not Included 877-838-8367 x105 support @ admon.com | admon.com Simple and Easy Endoscopy Display on Computers or Tablets* Air, Water & Working Channels High Resolution + Super Bright LED's No Processor or Light Processor Needed Available in 1.0m, 1.5m & 3.0m Lengths See at NAVC at Booth # 1509