Submucosal dissection and debridement for migratory esophageal foreign body removal in an elderly patient with acute presentation: A case report.

RATIONALE: Migratory esophageal foreign bodies (EFB) with submucosal migration and infection pose significant challenges in high-risk elderly patients. While standard endoscopy manages superficial cases, guidelines lack strategies for deeply embedded EFBs with infection risks. This study aims to evaluate endoscopic submucosal dissection (ESD) combined with en bloc extraction and precision debridement as a nonsurgical approach for octogenarians, specifically addressing infection control issues in endoscopic EFB management.

PATIENT CONCERNS: In this report, we present a case of an 84-year-old woman who developed acute dysphagia accompanied by high fever following fish bone ingestion. Initial endoscopic examination revealed a distal esophageal erosion (15 mm), with no direct observation of a foreign body.

DIAGNOSES: A computed tomography scan revealed proximal esophageal hyperdensity (non-perforating), later confirmed by endoscopic ultrasound as a 5.4 mm hypoechoic lesion with a hyperechoic core, indicating submucosal migration of the fish bone. Accompanying pyrexia (38.7 °C) and leukocytosis (white blood cells 12.0 × 10⁹/L) suggested inflammatory progression.

INTERVENTIONS: A structured multidisciplinary team approach was implemented, culminating in single-session ESD with en bloc foreign body extraction and precision debridement under monitored anesthesia care. The patient received intravenous cefoperazone sodium and sulbactam sodium for 48 hours post-procedure.

OUTCOMES: The en bloc EFB extraction via ESD (35 minutes) achieved complete debridement without bleeding or perforation. Postoperative antibiotics (48-hour course) resolved fever (38.7 °C → 36.8 °C) within 24 hours and normalized leukocytosis (white blood cells 12.0 → 6.8 × 10⁹/L). Oral intake progressed from liquids (day 3) to soft solids (day 7), with telemedicine follow-up confirming sustained dysphagia resolution. Discharge occurred on day 5 with no hematemesis/melena, and 30-day monitoring revealed no complications (strictures, aspiration), demonstrating procedural safety for high-risk octogenarians.

LESSONS: This preliminary experience highlights the potential utility of ESD for foreign body clearance alongside selective debridement in managing migratory EFB complicated by localized infection and acute dysphagic manifestations in octogenarian patients, thereby proposing a feasible nonsurgical alternative approach.