From snares, Roth nets, forceps and tripod prongs to overtubes and soft distal scope attachments, a myriad of instruments are available to remove swallowed objects with sharp ends, such as pens, pins, and pencils. However, the search for an easy-to-use and versatile tool continues. A large transparent distal attachment cap, remOVE SecureCap, was developed by Ovesco as part of the remOVE System designed to remove clip fragments of the company’s over-the-scope clip and full-thickness resection device (Figure 1).
In this edition of EndoHacks, we report on the novel use of this “mega” cap for removing a swallowed sharp metal object such as a ballpoint pen from inside the stomach using the following steps (Figure 2).
Slowly advance the distal part of the cap onto the sharp object (panel 2A).
Once the grasping forceps (rat teeth, alligator or remOVE forceps) is on the proximal tip, close the forceps slowly, as closing too quickly may cause the forceps to slide over the foreign body (panel 2B).
Once the forceps is closed tightly, go ahead and pull the proximal end of the foreign body into the cap (panels 2B and 2C).
Once the pointed tip is inside the cap (panel 2C), commence pulling the scope out. It is very important that the forceps shaft is held with the left hand in place. Keep insufflating air or carbon dioxide to distend the esophageal lumen, and gently torque the scope right and left.
Gently pull the scope out while continuously torquing right and left. The torquing maneuver decreases the chances the pen tip gets caught or hung up on the esophageal mucosa or any of the esophageal anatomic (physiologic) stenotic areas. The mega cap holds the sharp end inside, preventing external damage such as laceration or perforation.
For the final extraction maneuver, the patient’s neck should be hyperextended, and the assistant should be ready to catch the pen inside the mouth (panel 2D).
In a recent case, the entire extraction procedure took about five minutes.
This novel cap is a new addition to the armamentarium for removing long, sharp, and pointed foreign bodies from inside the gastrointestinal tract. This easy-to-use mega cap has advantages over overtubes, which are harder to handle and not always available. The mega cap also offers an advantage over small caps due to its larger capacity volume and elasticity, and it beats the capuchon foreign body retrieval hood, which is floppy and non-transparent.
One potential disadvantage is that the mega cap is more expensive than traditional hard caps. However, safe and rapid extraction of sharp-ended foreign bodies warrants this additional expense.
We always recommend doing ex vivo hands-on training to remove foreign bodies to improve handling skills and adapt to classic and novel devices.
Dr. Mergener is a member of the Gastroenterology & Endoscopy News editorial board.
See endocollab.com for more information, including videos, quick tips and lectures on these and many other practical endoscopy tricks and techniques.
Do you have your own tips and tricks in endoscopy?
to share, send them to smtilyou@mcmahonmed.com, and we will consider them for a future installment of EndoHacks.
This article is from the April 2025 print issue.