Faculty Collaboration Database

Safe and effective management of esophageal coins in children with bougienage. Surgery 2015 Oct;158(4):1065-70; discussion 1071-2

Date

08/05/2015

Pubmed ID

26239181

DOI

10.1016/j.surg.2015.06.025

Scopus ID

2-s2.0-84940789433 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

BACKGROUND: Coins are the foreign body most commonly ingested in infants and children. Coins retained in the esophagus require intervention to prevent complications. Management of retained esophageal coins remains variable both between and within institutions. We hypothesize that the incorporation of bougienage in the management of pediatric esophageal coins is safe and more cost-effective compared with traditional management strategies that use endoscopy.

METHODS: We conducted a retrospective review of infants and children diagnosed with an esophageal foreign body managed at Children's Hospital of Wisconsin between January 2003 and June 2012. Pediatric otolaryngologists (ear-nose-throat, ie, ENTs) or pediatric surgeons manage all children with esophageal foreign bodies in a prospective call schedule that alternates weekly.

RESULTS: During an 8.5-year period, 1,642 children were diagnosed with esophageal foreign bodies and 518 had a retained coin. For esophageal coins, ENT managed 218 cases and pediatric surgery managed 300. ENTs preferentially used endoscopy for coin removal, whereas pediatric surgeons used either endoscopy or esophageal bougienage for selected children meeting specific criteria. Bougienage was successful at advancing the coin into the stomach in 94% of patients, and endoscopy was successful at removing the coin from the esophagus in 100% of patients. The mean duration of stay was 0.6 days for endoscopy by ENT, 0.6 days for endoscopy by pediatric surgery, and 0.1 days for bougienage (P < .05). The median hospital charge was $4,593 for endoscopy by ENT, $5,379 for endoscopy by pediatric surgery, and $579 for bougienage (P < .05). There were 3 complications each in the endoscopy group for ENT and pediatric surgery. There were no complications in children undergoing bougienage.

CONCLUSION: This is the first case series evaluating the management of children with esophageal coins using a prospective assignment to endoscopy versus endoscopy or bougienage. Our data support bougienage as a safe and cost-effective treatment for managing retained esophageal coins in selected children.

Author List

Heinzerling NP, Christensen MA, Swedler R, Cassidy LD, Calkins CM, Sato TT

Authors

Casey Matthew Calkins MD Professor in the Surgery department at Medical College of Wisconsin
Laura Cassidy PhD Associate Dean, Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Cost-Benefit Analysis
Dilatation
Esophagoscopy
Esophagus
Female
Foreign Bodies
Humans
Infant
Male
Numismatics
Retrospective Studies
Treatment Outcome
Wisconsin