xtraction of meat and other foods from the esophagus_ at the
level of the upper thoracic aperture is usually readily accomplished
with the esophageal speculum and forceps. In certain cases the
mechanical spoon will be found useful. Should the bolus of food be
lodged at the lower level the esophagoscope will be required.

_Extraction of Foreign Bodies from the Strictured Esophagus_.--Foreign
bodies of relatively small size will lodge in a strictured esophagus.
Removal may be rendered difficult when the patient has an upper
stricture relatively larger than the lower one, and the foreign body
passing the first one lodges at the second. Still more difficult is
the case when the second stricture is considerably below the first,
and not concentric. Under these circumstances it is best to divulse
the upper stricture mechanically, when a small tube can be inserted
past the first stricture to the site of lodgement of the foreign body.

_Prolonged sojourn of foreign bodies in the esophagus_, while not so
common as in the bronchi is by no means of rare occurrence. Following
their removal, stricture of greater or less extent is almost certain
to follow from contraction of the fibrous-tissue produced by the
foreign body.

_Fluoroscopic esophagoscopy_ is a questionable procedure, for the
esophagus can be explored throughout by sight. In cases in which it is
suspected that a foreign body, such as pin, has partially escaped from
the esophagus, the fluoroscope may aid in a detailed search to
determine its location, but under no circumstances should it be the
guide for the application of forceps, because the transparent but
vital tissues are almost certain to be included in the grasp.

[197] Complications and Dangers of Esophagoscopy for Foreign Bodies.
Asphyxia from the pressure of the foreign body, or the foreign body
plus the esophagoscope, is a possibility (Fig. 91). Faulty position of
the patient, especially a low position of the head, with faulty
direction of the esophagoscope may cause the tube mouth to press the
membranous tracheo-esophageal wall into the trachea, so as temporarily
to occlude the tracheal lumen, creating a very dangerous situation in
a patient under general anesthesia. Prompt introduction of a
bronchoscope, with oxygen and amyl nitrite insufflation and artificial
respiration, may be necessary to save life. The danger is greater, of
course, with chloroform than with ether anesthesia. Cocain poisoning
may occur