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Esophageal coin removal in children - bougienage versus endoscopy

June's issue of the Journal of Clinical Gastroenterology compares the bougienage technique of esophageal coin removal in children to the endoscopy method

News image

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Foreign body ingestion is a common pediatric problem, and coins are by far the most commonly-ingested objects.

When ingested, coins become lodged in the esophagus and they can cause serious complications if they are not removed in a timely manner.

Endoscopic removal is the preferred treatment in many pediatric centers as its safety and effectiveness are well established.

90% of children were treated successfully using bougienage.
Journal of Clinical Gastroenterology

Dr Ahmed H. Dahshan and colleagues performed this study to evaluate safety and effectiveness of an alternative method of managing esophageal coins, using bougienage technique.

Previously healthy children presenting to the local emergency room with uncomplicated, witnessed coin ingestion of less than 24 hours duration were prospectively recruited with an intent-to-treat analysis.

A single oral passage of a Hurst bougie dilator was performed by a gastroenterologist to dislodge the esophageal coin into the stomach.

If bougienage was successful (the x-ray showed the coin in the stomach), patients were discharged and instructions were given for monitoring stools until the passage of the coin through the anus was confirmed.

If bougienage was unsuccessful, the child developed symptoms at any time or if a coin remained intragastric for 4 weeks, endoscopic removal was planned.

Children whose parents declined to participate in the bougienage treatment received the standard endoscopic removal and their hospital records were used as controls.

A total of 10 children (6 boys and 4 girls) were enrolled in this study, with a mean age of 3.2 years (ranging from 11 months to 10 years).

All received little or no sedation.

Nine children (90%) were treated successfully using bougienage, all of whom passed the ingested coins spontaneously, with a mean duration of 2.6 days (1 to 7 days) and without subsequent intervention.

A single patient failed bougienage and underwent endoscopic removal. 3 children declined bougienage treatment and underwent endoscopic removal.

There were no reported minor or major adverse events with any of our cases.

The mean health care cost for the hospital visit for bougienage treatment was $1210, compared with $3100 for the endoscopic removal (P<0.001).

Furthermore, the mean time spent in the hospital from diagnosis to discharge was 2 hours for bougienage-treated patients compared with 8 hours for endoscopic treatment (P<0.001).

Dr Dahshan and the team concluded that, "Bougienage of impacted esophageal coins is an effective, safe, and more economic treatment modality for selected pediatric patients with uncomplicated coin ingestion", and that, "This simple technique may provide a valuable tool to emergency room physicians or primary care doctors especially when endoscopy is not readily available".

Journal of Clinical Gastroenterology 2007; 41 (5), 454-456
29 May 2007

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