50 Years Ago in The Journal of Pediatrics:

Article Outline

• Copyright

Laff HI, Allen RP. J Pediatr 1956:563-8

The use of magnets for removal of foreign objects from the esophagus, stomach, and tracheo-bronchial tree was first described over 100 years ago. The use of permanent magnets in medical devices has become increasingly widespread over the past 5 decades. Alnico magnets (alloys of Al, Fe, Ni, Co, Ti) were the first types of permanent magnets that were used for biomedical applications. The authors describe their successful experience with removal of ingested radio-opaque foreign objects using various sizes of Alnico magnets over a 5 year period (1949-1955). They also discuss their management protocol depending upon patient cooperation, object shape and size, and site of lodgment. The appropriate magnet was either attached to a catheter (passed nasally) or string (passed orally) and introduced without sedation or anesthesia if the child was cooperative. Fluoroscopic guidance was used to determine successful contact of the object to the magnet and its subsequent removal, occasionally under sedation or anesthesia. An endoscopist was always available in case of aspiration during removal.

Radiographic evaluation is still the first step to identify the object and its location, and coins continue to be the most common culprit. Although most swallowed foreign objects pass through the gastrointestinal tract uneventfully, those lodged in the esophagus for extended periods and those causing symptoms or have the potential to cause damage, should be removed. Ingested button (disc) battery lodged in the esophagus has emerged as a common indication for emergent removal due to its potential for causing chemical burns in a short period of time. Esophageal food impaction due to eosinophilic esophagitis is also becoming increasingly common.

Advances in the use of anesthetic agents and endoscopic techniques have promoted endoscopic removal under general anesthesia as the most popular method for retrieval of a foreign object from the gastrointestinal tract. Those lodged at or above the thoracic inlet continue to be removed using a rigid scope while a flexible video endoscope is used for more distal objects. The availability of several extraction devices including a variety of grasping forceps, nets, baskets, and overtubes, has provided the endoscopist with a wider choice to pick the most appropriate retrieval device depending upon the size and shape of the object as well as the location.