DEVICE CHOICE AND EXPERIENCE LEVEL IN ENDOSCOPIC FOREIGN OBJECT RETRIEVAL - AN IN-VIVO STUDY

Background: Successful foreign object retrieval may depend on device c hoice and the experience level of the endoscopist, although these fact ors have not been systematically evaluated. Methods: In anesthetized p igs, the ability to retrieve foreign objects (metal tack, burton disc battery, wooden toothpick) placed endoscopically into the stomach was assessed. Seven university medical center gastroenterology attending p hysicians (5 clinical and 2 basic science research [BSR]), and 4 fello ws-in-training participated. The devices used were the Roth retrieval net, rat tooth forceps, Dormia basket, polypectomy snare, and radial j aw forceps. The time to retrieve each object into an esophageal overtu be within a 5 minute maximum was measured. Results: Only the Roth net and Dormia basket were successful in retrieving the button disc batter y, although the Both net was superior (100% vs 27%, Fisher p < 0.025). Ail devices were equally successful at retrieving the tack (82% to 10 0%, p = NS). The snare was significantly faster than the Roth net (p < 0.05). For the tack, there were significantly fewer difficulties enco untered with the snare than the Roth net (Fisher p < 0.03). The Both n et was incapable of retrieving the toothpick; the other devices were e qually successful (91% to 100%). The clinical attendings had a signifi cantly higher success rate (95%) than the fellows (82%, chi squared p < 0.05) or combined fellows/BSR attendings (80%, p < 0.02), and were s ignificantly faster than the fellows (p < 0.0002) or the fellows/BSR a ttendings (p < 0.0003). Conclusions: The Roth net is the best device f or retrieving smooth objects such as the button disc battery. For shar p objects, such as the tack and toothpick, best results were achieved with the snare, although the forceps were also effective. More experie nced endoscopists had higher success rates and faster retrieval times. Both device choice and the experience level of the endoscopist have a n impact on successful foreign object retrieval.