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The spontaneous passage of esophageal coins in children
J V Soprano1, G R Fleisher, K D Mandl
1Department of Pediatrics, Children's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
Insights
Children with esophageal coins have a 28% chance of spontaneous passage to the stomach. Initial coin location in the esophagus did not significantly affect spontaneous passage rates in simple cases.
Area of Science:
- Pediatric Gastroenterology
- Emergency Medicine
- Radiology
Background:
- Esophageal coin ingestion is common in children.
- Determining the need for invasive procedures requires understanding spontaneous passage likelihood.
Purpose of the Study:
- To assess the probability of spontaneous esophageal coin passage to the stomach in pediatric patients.
- To evaluate the influence of initial coin location on spontaneous passage.
Main Methods:
- Retrospective review of medical records and radiographs of pediatric patients (≤18 years) with esophageal coins.
- Categorization of cases into "simple" and "complex" based on clinical factors.
- Analysis of spontaneous passage rates and time to passage based on initial coin location.
Main Results:
- Of 116 cases, 84 were simple and 32 complex. In simple cases, spontaneous passage occurred in 28% (16/58).
- Initial coin location (proximal, middle, distal esophagus) did not significantly impact spontaneous passage in simple cases (P >.05).
- No spontaneous passage was observed in complex cases (0/14).
Conclusions:
- Pediatric patients with a single esophageal coin, presenting within 24 hours without prior esophageal issues or respiratory compromise, have a 28% likelihood of spontaneous passage.
- Observation for 12-24 hours before intervention may reduce complications and healthcare costs.
- Spontaneous passage occurs regardless of whether the coin is in the upper or lower esophagus.
Objectives:
To determine the likelihood of spontaneous passage of esophageal coins to the stomach in children and to determine the effect of initial coin location on spontaneous passage.
Design:
Retrospective review of medical records and radiographs.
Subjects:
Consecutive patients 18 years or younger presenting during a 24-month period (October 1995 to September 1997) whose evaluation revealed an esophageal coin.
Setting:
The emergency department of a large, urban academic children's hospital.
Main Outcome Measures:
Independent measures were time between ingestion and radiographs, initial location of the coin, and categorization of case as "simple" (patients without a history of esophageal disease or surgery, with a single esophageal coin lodged less than 24 hours, and with no respiratory compromise on presentation) or "complex." Dependent measures were spontaneous passage of the coin to the stomach and the time to passage.
Results:
A total of 116 cases were included in the analysis, of which 84 were simple and 32 complex. Among the 84 simple cases, the coin was initially located in the proximal third of the esophagus in 54 (64%), the middle third in 7 (8%), and the distal third in 22 (26%). For the 32 complex cases, the initial location of the coin was the proximal third of the esophagus in 27 (84%) and the middle third in 5 (16%). Subsequent radiographs were obtained in the emergency department in 58 (69%) of the simple cases. Among these cases, spontaneous passage of the coin to the stomach occurred in 16 (28% [95% confidence interval, 21%-41%]). By initial coin location, spontaneous passage in this group occurred in 22% (7/32) of proximal, 33% (2/6) of middle, and 37% (7/19) of distal esophageal coins (P >.05). Subsequent radiographs were obtained in 14 (44%) of the complex cases; no coin had passed spontaneously to the stomach in these patients (0% [95% confidence interval, 0%-20%]).
Conclusions:
Children with a single esophageal coin seen within 24 hours of ingestion, who have no history of esophageal disease and no respiratory compromise on presentation, have a 28% chance of spontaneous passage of the coin to the stomach. Coins in the upper as well as the lower esophagus pass spontaneously. Observing these children for 12 to 24 hours prior to invasive procedures will reduce complications and costs.