3.1 Comparison of Successfully Removed Foreign Bodies between the Two Groups
A total of 127 cases with successfully removed foreign bodies were analyzed. Table 1 presents the sex distribution in the serrated biopsy forceps group and foreign body forceps group, with a slightly higher prevalence of females in both groups. In the serrated biopsy forceps group, no cases were reported for children (below 14 years old), with the cases predominantly comprising middle-aged individuals (14-59 years), while cases involving elderly adults (60 years and above) were relatively few. Similarly, in the foreign body forceps group, middle-aged cases were the most prevalent, followed by a relatively higher proportion of elderly cases compared to the biopsy forceps group. Additionally, a small number of pediatric cases (below 14 years old) were observed in the foreign body forceps group, as depicted in Table 1.
In the reports of successful removal in the serrated biopsy forceps group and the foreign body forceps group, there was minimal difference in the number of cases located in the pharynx, middle esophagus, and lower esophagus. However, for cases located in the upper esophagus, the foreign body forceps group exhibited a higher count than the serrated biopsy forceps group, although this difference lacked statistical significance between the two groups (P>0.05), as shown in Table 2.
The number of successfully removed fish bones did not significantly differ between the two groups. However, in the foreign body forceps group, there were more successfully removed foreign bodies of categories such as poultry bones, other fragmented bones (from pig, cow, sheep, frog, etc.), fruit pits, and other types (food masses, toothpicks, metal objects, dentures, pen caps, etc.), compared to the serrated biopsy forceps group. This difference between the two groups was statistically significant (P<0.05), as shown in Table 2.
In this study, the foreign bodies were categorized into four types based on their different shapes. Among the fine needle-shaped foreign bodies, fish bones were the most common, with comparable numbers of successfully removed cases in both groups. Among flat-shaped foreign bodies, poultry bones were the most prevalent, followed by other fragmented bones (from pigs, cows, sheep, frogs, etc.), with fish bones being relatively less common. In this category, the serrated biopsy forceps group had significantly fewer successful removals compared to the foreign body forceps group, as shown in Tables 2 and 3.
Irregular-shaped foreign bodies were less common, and they were often associated with fish bones and other fragmented bones (from pigs, cows, sheep, frogs, etc.). The numbers of these foreign bodies were similar between the two groups. Other types of foreign bodies (such as spindle-shaped, lumpy, elongated, and rounded) were commonly found in fruit pits and other miscellaneous items (food masses, toothpicks, metal objects, dentures, pen caps, etc.). Interestingly, the serrated biopsy forceps group had no cases of this type, while the foreign body forceps group successfully removed 17 cases. This difference between the two groups was statistically significant (P<0.05), as shown in Tables 2 and 3.
In the group where serrated biopsy forceps were used for successful foreign body removal, there were no cases of mucosal injury. In the group where foreign body forceps were used, there were 5 cases of mucosal injury, as shown in Table 4.
3.2 Results of Failed Foreign Body Removal
In this study, within the group using serrated forceps, there were 3 cases of failed foreign body retrieval, all of which involved thin needle-like fish bones (Table 5 and Table 6). Among these cases, 2 failures were attributed to patients experiencing nausea and vomiting during the procedure, and 1 case resulted from the slipping of a thin needle-like fish bone during retrieval attempts.
In the group using foreign body forceps, there were a total of 13 cases of unsuccessful foreign body retrieval. Fish bones and other fragmented bones (such as from pigs, cows, sheep, frogs, etc.) were the most commonly encountered types of foreign bodies in these failures. Additionally, there were a few cases involving poultry bones and other objects (such as food masses, toothpicks, metal objects, dentures, and pen caps). Among the different types of foreign bodies, flat fragments were the most prevalent, followed by thin needle-like shapes and irregular shapes, while other types (spindle-shaped, clumps, blunt long shapes, round blunt shapes, etc.) were less common (Table 5 and Table 6). Among the 13 cases of retrieval failures, 7 were attributed to patients experiencing nausea and vomiting, which hindered the retrieval process. Three cases resulted from the brittleness of the foreign body, causing it to break during retrieval attempts. Two cases involved the foreign body slipping from the forceps, and in 1 case, the foreign body was too large for successful retrieval.