Esophageal Button Battery in the Pediatric Population: Experience from a Tertiary Care Center

Anand, Sachit; Jain, Vishesh; Agarwala, Sandeep; Dhua, Anjan Kumar; Yadav, Devendra Kumar

doi:10.1007/s12098-020-03222-1

Cited by 15 publications

(16 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Even the patient with an EB who expelled the foreign body before endoscopy had a severe esophageal lesion (Grade IIIa), which reinforces the importance of performing an endoscopy even in these situations (in cases of EB on the X-ray). We found no statistically significant association between duration of exposure and severity of esophageal lesions, in accordance with what is reported in recent studies ( 6 , 29 ). Nevertheless, we had 4 cases of perforation (29%), two confirmed by CT-scan, with a median exposure time of 2 h-8 h-7 days−7 days.…”

Section: Discussionsupporting

confidence: 93%

“…Late battery removal is another recognizably risk factor in complications ( 16 ). Although endoscopy was performed shortly after hospital admission in our sample, median time to battery removal in cases of EB was 7 h. Removal was performed later than recommended (≥ 6 h) in 80% of cases, as reported in other studies [with a median time from ingestion to removal of 6 h ( 5 , 25 )/7.5 h ( 29 ) and 8 h ( 30 )] and shorter than other case reports [with 17 h ( 6 ) and 36 h ( 31 )]. This later removal was due to late referral in 55% of cases, as most of the patients (89%) were referred from other centers; some of them remote and due to unknown history of ingestion in 45% (all of them with EB), as the patients went to the ED only after unspecific symptoms appeared.…”

Section: Discussionsupporting

confidence: 52%

“…In a recently published Indian study ( 29 ), only 5/52 children had complications (10%), all of them with Grade III caustic injury and 80% with unwitnessed ingestion. The complications were pneumothorax in 4%, and pneumomediastinum, TEF, and AEF each one in 2%.…”

Section: Discussionmentioning

confidence: 95%

See 2 more Smart Citations

Battery Ingestion in Children, an Ongoing Challenge: Recent Experience of a Tertiary Center

et al. 2022

View full text Add to dashboard Cite

IntroductionMorbidity related to childhood battery ingestions (BI) has increased recently due to the expanding use of larger lithium cells. A prompt endoscopic removal is vital to prevent severe complications in cases of esophageal batteries (EB).Materials and MethodsA retrospective, descriptive study of admissions for BI requiring endoscopic removal in a tertiary hospital's pediatric emergency department (Jan. 2011/Dec. 2020).ResultsWe had 35 cases, with an increasing incidence in the last 6 years; median age, 26 m (8 m-10 years), witnessed ingestion in 86%. On the X-ray: 14 (40%) had an EB, 21 (60%), a gastric battery (GB). Symptoms were present in 57% (100% EB/24% GB), and vomiting was the most frequent (50%). Endoscopy revealed: EB, 13 (37%); GB, 17 (49%); duodenal battery, 1 (3%); no battery, 4 (11%). Median time to removal: EB, 7 h (2 h-21days); GB, 12 h (2 h-3 days). All the patients with EB on the X-ray (14) had severe mucosal injury (Zargar classification): Grade IIIa, 7 (50%); IIIb, 5 (36%); IV, 2 (14%). CT-scan showed perforation in 2 patients (total, 4; 29% of EB). In patients with GB (21), 14 (67%) had mucosal damage; 13 (93%), mild (< Grade III, two esophageal erosions); 1 (7%) IIIa (esophageal ulceration). A statistically significant association between exposure time, younger age or battery size and severity of endoscopic lesions was found in EB location. There were no mortality cases. Acute complications occurred in 57% of EB: infection, 50%; perforation, 29%; pneumomediastinum/stridor, 14%; pneumothorax/subglottic stenosis/hemodynamic instability, 7 vs. 0% GB. Stenosis subsequently developed in 6 (43%) of EB: mild, 4 cases (29%); severe, 2 cases (14%, one resolved after endoscopic dilation; one needed a gastrostomy and esophagocoloplasty).ConclusionWe verified recent increase in admissions due to battery ingestions and associated complications, despite the availability of an emergency pediatric endoscopy team. The patients with EB had more severe mucosal injury and poorer short/long-term outcomes. Children with GB had milder lesions, although the presence of a GB did not exclude esophageal injury. The availability of actual data from national referral centers will support advocacy efforts among stakeholders, including industry representatives and policy makers, in preventing worldwide button battery injury.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 52%

See 1 more Smart Citation

Battery Ingestion in Children, an Ongoing Challenge: Recent Experience of a Tertiary Center

et al. 2022

View full text Add to dashboard Cite

show abstract

“…While most ingested BBs pass spontaneously without any complications, especially beyond the stomach [ 3 ], complications usually occur from BBs that are stuck in the esophagus. The most frequent site of esophageal dislodgment is in the upper esophagus [ 3 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…A review of published cases was performed using PubMed and the National Capital Poison Canter. Fatal outcomes were reported in 50 cases [ 5 , 6 , 24 – 42 ], of which 58% (29 cases) were BB-induced injuries, and 42% (21 cases) were not related to BBs. Among the BB-related cases, 27 were diagnosed with AEF and 2 cases had other vascular erosions.…”

Section: Discussionmentioning

confidence: 99%

A 2-Year-Old Boy Who Developed an Aortoesophageal Fistula After Swallowing a Button Battery, Managed Using a Novel Procedure with Vascular Plug Device as a Bridge to Definitive Surgical Repair

et al. 2021

View full text Add to dashboard Cite

Patient: Male, 2-year-old Final Diagnosis: Aortoesophageal fistula Symptoms: Esophageal foreign body • gastrointestinal bleeding Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology • Pediatrics and Neonatology Objective: Rare disease Background: Button batteries (BBs) can be inhaled or swallowed accidentally, particularly by infants and children, who can present as a surgical emergency with a fatal outcome. This report is of a case of a 2-year-old boy who developed an aortoesophageal fistula (AEF) after swallowing a button battery and was successfully treated using a novel vascular plug device as a bridge to definitive surgical repair. AEF is diagnosed using computed tomography angiography (CTA), after laparotomy, and using aortography. Aortic endovascular stenting and vascular occluder placement is a minimally invasive emergency option until definitive treatment can be provided. The surgical options include repair the aortic defect primarily, or the diseased segment of the aorta is replaced with a graft. Case Report: A 2-year-old boy presented with hematemesis 9 days after ingestion of a button battery, which was removed endoscopically 16 hours after the incident. The patient was resuscitated aggressively and diagnosed to have AEF using computed tomography angiography (CTA). The aorta was successfully repaired using a vascular plug device, which kept the patient safe until the definitive surgical treatment was done 2 months later. The defect was repaired with direct anastomosis and completed with a patch of bovine pericardium, as well as closure of the fistula from the esophageal side with stitches. Conclusions: This report presents a rare but previously reported complication of swallowing a button battery, resulting in an aortoesophageal fistula. The aorta was successfully repaired using a vascular plug as a minimally invasive emergency option, which is considered as a lifesaving procedure and a bridge for definitive repair.

show abstract

Pediatric Esophageal Button Battery Protocol Reduces Time From Presentation to Removal

Goh,

Siu,

Philteos

et al. 2024

The Laryngoscope

View full text Add to dashboard Cite

ObjectiveEvaluate implementation of an institutional protocol to reduce the time to removal of esophageal button battery (BB) and increase use of mitigation strategies.MethodsWe developed a protocol for esophageal BB management [Zakai's Protocol (ZP)]. All cases of esophageal BB impaction managed at a tertiary care center before and after implementation from 2011 to 2023 were reviewed. Time to BB removal, adherence to critical steps, and use of mitigation strategies (honey/sucralfate, acetic acid) were evaluated.ResultsFifty‐one patients (38 pre‐ZP, 13 post‐ZP) were included. Median age was 2.3 years (IQR 1.3–3.4). After implementation, the time from arrival at the institution to arrival in the operating room (OR) reduced by 4.2 h [4.6 h (IQR 3.9–6.5) to 0.4 h (IQR 0.3–0.6), p < 0.001] and there was improvement in all management steps. The number of referrals direct to otolaryngology increased from 51% to 92%, arrival notification increased from 86% to 100%, avoidance of second x‐ray increased from 63% to 100%, and direct transfer to OR increased from 92% to 100%. Adherence to mitigation strategies such as preoperative administration of honey or sucralfate increased from 0% to 38%, intraoperative use of acetic acid from 3% to 77%, and nasogastric tube insertion from 53% to 92%.ConclusionImplementation of ZP substantially reduced the time to BB removal and the use of mitigation strategies in our tertiary care institution. Additional strategies focused on prevention of BB ingestion, and shortening the transfer time to the tertiary care hospital are required to prevent erosive complications.Level of EvidenceLevel 3 Case‐series Laryngoscope, 2024

show abstract

Esophageal Button Battery in the Pediatric Population: Experience from a Tertiary Care Center

Cited by 15 publications

References 17 publications

Battery Ingestion in Children, an Ongoing Challenge: Recent Experience of a Tertiary Center

Battery Ingestion in Children, an Ongoing Challenge: Recent Experience of a Tertiary Center

A 2-Year-Old Boy Who Developed an Aortoesophageal Fistula After Swallowing a Button Battery, Managed Using a Novel Procedure with Vascular Plug Device as a Bridge to Definitive Surgical Repair

Pediatric Esophageal Button Battery Protocol Reduces Time From Presentation to Removal

Contact Info

Product

Resources

About