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30 Years of Flipping the Coin-Heads or Tails?
Wendy Jo Svetanoff1, Robert M Dorman1, Charlene Dekonenko1
1Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States.
Introduction:
Swallowed coins are a frequent cause of pediatric emergency department visits. Removal typically involves endoscopic retrieval under anesthesia. We describe our 30-year experience retrieving coins using a Foley catheter under fluoroscopy ("coin flip").
Materials And Methods:
Patients younger than 18 years who underwent the coin flip procedure from 1988 to 2018 were identified. Failure of fluoroscopic retrieval was followed by rigid endoscopic retrieval in the operating room. Detailed subanalysis of patients between 2011 and 2018 was also performed.
Results:
A total of 809 patients underwent the coin flip procedure between 1988 and 2018. Median age was 3.3 years; 51% were male. The mean duration from ingestion to presentation was 19.8 hours. Overall success of removal from the esophagus was 85.5%, with 76.5% of coins retrieved and 9% pushed into the stomach. All remaining coins were retrieved by endoscopy. Complication rate was 1.2% with nine minor and one major complications, a tracheal tear that required repair. In our recent cohort, successful fluoroscopic removal led to shorter hospital lengths of stay (3.2 vs. 18.1 hours, p < 0.001).
Conclusion:
Patients who present with a coin in the esophagus can be successfully managed with a coin flip, which can be performed without hospital admission, with rare complications.
Insights
The Foley catheter "coin flip" successfully removes esophageal coins in children, often avoiding hospitalization. This minimally invasive technique offers a safe and effective alternative to endoscopy for pediatric coin retrieval.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Procedures
- Medical Device Innovation
Background:
- Swallowed coins are a common pediatric emergency.
- Endoscopic retrieval under anesthesia is the standard treatment.
- A Foley catheter technique under fluoroscopy, termed "coin flip," offers an alternative.
Purpose of the Study:
- To evaluate the 30-year experience with the Foley catheter "coin flip" procedure for esophageal coin removal in children.
- To assess the efficacy, safety, and outcomes of this minimally invasive approach.
Main Methods:
- Retrospective review of pediatric patients (<18 years) undergoing the "coin flip" procedure (1988-2018).
- Analysis of fluoroscopic retrieval success, need for subsequent endoscopy, and complication rates.
- Subanalysis of a recent cohort (2011-2018) for hospital length of stay.
Main Results:
- 809 pediatric patients treated over 30 years.
- Overall esophageal coin removal success rate of 85.5% (76.5% retrieved, 9% pushed into stomach).
- Low complication rate (1.2%), with shorter hospital stays in recent cohort (3.2 vs. 18.1 hours).
Conclusions:
- The Foley catheter "coin flip" is a safe and effective method for pediatric esophageal coin removal.
- This procedure can often be performed without requiring hospital admission.
- It presents a valuable, less invasive alternative to traditional endoscopic retrieval.
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