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Initial clinical application of tissue pH neutralization after esophageal button battery removal in children

Kris R Jatana1, Christine L Barron2, Ian N Jacobs3,4

  • 1Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital and Wexner Medical Center at Ohio State University, Columbus, Ohio.

The Laryngoscope
|March 6, 2019
PubMed

Insights

Acetic acid irrigation after pediatric button battery removal safely neutralizes esophageal pH, improving tissue appearance and preventing perforation or strictures. This technique is recommended for managing these serious injuries.

Area of Science:

  • Pediatric Gastroenterology
  • Otolaryngology
  • Emergency Medicine

Background:

  • Pediatric esophageal button battery (BB) injuries pose significant risks, including ongoing morbidity and mortality even after removal.
  • The alkaline environment created by BBs can lead to progressive tissue damage.

Purpose of the Study:

  • To evaluate the safety and efficacy of intraoperative tissue pH neutralization using 0.25% acetic acid irrigation following BB removal in pediatric patients.
  • To present initial safety data for this novel application.

Main Methods:

  • A retrospective case series involving pediatric patients who underwent rigid esophagoscopy for BB removal.
  • Irrigation of the esophageal injury site with 120-150 mL of sterile 0.25% acetic acid (pH 3) after BB removal.
  • Assessment of visual tissue appearance, esophageal perforation, and stricture formation.

Main Results:

  • Six pediatric patients with esophageal BBs removed after 2-18 hours were treated.
  • No patients exhibited thermal tissue injury post-irrigation.
  • All patients demonstrated improved visual esophageal tissue appearance.
  • No immediate or delayed esophageal perforations or strictures were observed.

Conclusions:

  • Intraoperative esophageal irrigation with 0.25% acetic acid is safe and effective in neutralizing the alkaline tissue microenvironment after BB removal.
  • This pH neutralization improves mucosal appearance and may prevent further liquefactive necrosis.
  • The technique aligns with current National Capital Poison Center guidelines for BB injury management.
Abstract

Keywords:
Button batteryacetic acidbattery injuryesophagealneutralizationpediatric injury

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