Timing of Button Battery Removal From the Upper Gastrointestinal System in Children

Abstract

The aim of the study was to investigate the appropriate time of removal of button batteries (BB) from the esophagus and stomach in children.Methods: This is a retrospective descriptive single-center study reviewing the medical records of all children with BB ingestion seen in the Royal Hospital between January 1, 2011, and December 31, 2014. All children younger than 13 years with a history of BB ingestion were included. Biodemographic data including age and sex were obtained. In addition, time of ingestion of BB, location of BB, time of endoscopic removal, and any complications were recorded.Results: Forty-six patients with BB ingestion were identified out of 385 who presented with foreign body ingestion (12%) during the study period. Twenty four (52%) were boys and 22 (48%) were girls. All children had BB of 20 mm in diameter. Two children had the BB in the esophagus, whereas 13 children had the BB in the stomach up on presentation. The mean time of presentation of children with BB in the esophagus was 1.75 hours after ingestion, whereas those with BB in the stomach presented on average 19.4 hours after ingestion (P < 0.035).An endoscopic intervention was done in only 8 of the 46 children. Two children had the BB in the esophagus and 6 children in the stomach. One child required intensive care unit with subsequent esophageal strictures. The mean time of esophageal BB removal was 1.7 hours from ingestion, whereas removal from the stomach was on average 27 hours after ingestion. Endoscopic injuries were noted in 87.5% of the children with BB in the esophagus or the stomach. No mortality occurred during the study period.Conclusions: Button batteries ingestion is a common problem with variable time of presentation to the emergency department. Esophageal BB presents the highest risk of injury even in as short time as 2 hours. Gastric mucosal injury can occur within 10 hours of ingestion. Button batteries of 20-mm diameter need to be urgently removed from the esophagus and be considered for removal earlier than 24 hours if in the stomach.

Evaluation of a Symptom-Based Algorithm for Managing Battery Ingestions in Children

“…16 This metric cannot be measured in much of the current literature, as recommended intervals for retrieval are often much sooner. 6 9 10 15 It is unknown how many of these patients may have passed the battery without intervention; however, data from our cohort suggest that spontaneous migration of button batteries is likely. Our recommendations and resultant algorithm most align with the recent recommendations from the 2021 ESPGHAN position statement.…”

“…14 Additional data have demonstrated that arrested battery progression and increased time within the gastrointestinal (GI) tract were not associated with worse or adverse outcomes, further confounding interpretation of time-sensitive ingested battery algorithms for batteries beyond the GE junction. 13 15 Difficulty with creating a widely accepted button battery ingestion protocol stems from the management of these asymptomatic patients, as symptomatic presentation is uniformly an indication for endoscopic or surgical retrieval for all published algorithms.…”

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

“…Thus, the authors suggest urgent removal of button batteries even in cases of gastric location. In another study ( 24 ), 6/13 patients with GB performed an endoscopy. Despite the relatively early removal time (median: 27 h), mucosal gastric injury was seen in 4/6–67% (Grade I in one, Grade IIa in two, Grade IIIa also in one).…”

Esophageal Diameter as a Function of Weight in Neonates, Children and Adolescents: Reference Values for Dilatation of Esophageal Stenoses

“…When infants swallow button cell batteries they need to be removed endoscopically very quickly to avoid severe local burns, often transmural. In such cases, a locally circumscribed stenosis of the esophagus may occur ( 7 , 8 ). These stenoses are also usually treated as described above.…”