Bleeding and foreign bodies are two conditions that need emergency endoscopy.

In case of bleeding, resuscitation of a hemodynamically unstable patient is mandatory before performing endoscopy. Endoscopy in patients with GI bleeding (GIB) is effective for diagnosis and treatment of most causes. There are a variety of endoscopic treatment modalities available for the management of GIB, including injection methods, cautery, hemostatic powder and mechanical therapy. Mechanical therapy refers to the use of a device that causes physical tamponade of a bleeding site. Currently, the only endoscopic mechanical therapies widely available are clips and band ligation devices. Hybrid techniques combining two modalities are also possible. If endoscopic therapy fails, interventional radiology or surgical approaches may be required. Indications and methods of gastrointestinal bleeding management will be presented herein.

The second part of the lecture will focus on foreign body extraction. The majority of ingested foreign bodies (80% or more) will pass spontaneously. Once through the esophagus the majority of foreign bodies including sharp objects will pass uneventfully. Foreign body ingestions predominantly occur in the pediatric population, with a peak incidence between the ages of 6 months and 6 years. In adults, true foreign body ingestion (i.e., nonfood objects) occurs more commonly in those with psychiatric disorders, developmental delay, alcohol intoxication, and in incarcerated individuals seeking secondary gain via release to a medical facility. The need for an intervention for foreign body ingestion depends on the patient’s age and clinical condition; the size, shape and content of the object; the anatomic location of the ingested object(s); and the time since ingestion. The perceived risk of aspiration, obstruction, or perforation determines the timing of endoscopy.

The use of an overtube or a protector hood is mandatory to protect the esophageal mucosa from lacerations during retrieval of sharp objects. The administration of glucagon 1.0 mg intra- venously has been advocated to induce relaxation of the distal esophagus, and helps retrieval. A variety of retrieval devices can be used such as foreign body forceps, polypectomies snare, tripod, retrieval net, and dormia basket. Another category of foreign bodies is implantable surgical devices. Successful endoscopic retrieval of migrated mesh, partially or fully migrated lap band, and intragastric balloon have been reported.