This article is a report by Robertson and Bowyer on three clinical cases in which EndoSheath® Technology with a 2.1-mm working channel (Vision Sciences, Orangeburg, NY) were used with a rhinolaryngofiberscope (ENF Type P3, Olympus, Tokyo, Japan) to remove fish bones impacted in the tongue base, vallecula, and pyriform fossa, respectively. In each case, the patient’s oral cavity and oropharynx were anesthetized and an endoscopic examination of the larynx and hypopharynx was performed to determine the location of the fish bone. Once the bone was visualized, biopsy forceps were introduced through the channel in the sheath to grasp one end of the bone. The bone was then removed through the nose while the endoscope was simultaneously withdrawn. There were no complications in any of the three cases.
Robertson and Bowyer noted that two methods by which a flexible endoscope could be used to remove fish bones from the laryngopharynx had previously been described. One employed an endoscope with an integral instrument channel for foreign-body forceps; the other used a flexible nasopharyngoscope to guide orally introduced forceps. However, according to the authors, these methods have the following disadvantages: many clinicians do not have access to a nasopharyngoscope with a biopsy channel; the presence of an integral instrument channel complicates endoscope decontamination; and manipulating a flexible endoscope and orally inserted forceps is technically demanding, often requires an assistant, and may not permit easy removal of more distally lodged bones. Robertson and Bowyer concluded that use of the channelled EndoSheath® Technology provides an inexpensive alternative to other methods of removing fish bones from the laryngopharynx.