Esophageal Bougienage for Management of Lodged Esophageal Coins: Safe, Effective, Efficient, and Underused
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Updated: Aug 27, 2025
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Published on: November 21, 2023
Tessa N Warner1, Madeline Genereux2, Amanda B Price3
1From the Department of Emergency Medicine.
Insights
Esophageal bougienage is a safe and effective procedure for removing lodged coins in children, offering significant cost and time savings over endoscopy. However, it is underutilized due to lack of provider education and awareness.
Area of Science:
- Pediatric Emergency Medicine
- Gastroenterology
- Medical Device Technology
Background:
- Lodged esophageal coins are a common pediatric emergency requiring prompt management.
- Esophageal bougienage and endoscopy are potential treatment options, each with distinct procedural characteristics.
- Understanding the comparative effectiveness and utilization patterns of these interventions is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the outcomes of esophageal bougienage for managing lodged esophageal coins in pediatric patients.
- To assess the current usage rates and identify barriers to esophageal bougienage among emergency providers.
- To compare the efficacy, safety, length of stay, and cost of bougienage versus endoscopy.
Main Methods:
- Retrospective chart review of pediatric patients with single lodged esophageal coins (November 2012 - December 2018).
- Comparison of procedural outcomes, complications, length of stay (LOS), and cost between bougienage and endoscopy groups.
- Survey of emergency physicians across multiple institutions to determine bougienage utilization and perceived barriers.
Main Results:
- Bougienage demonstrated high success rates (97%) with no major complications in 147 patients.
- Endoscopy managed 56 patients with 100% success but one major complication.
- Bougienage resulted in significantly shorter LOS (2.18 vs. 11.92 hours) and lower hospital charges ($3533 vs. $12,679) compared to endoscopy.
- Surveys revealed low bougienage usage (4.5%) and awareness (36.4%), with primary barriers including lack of training (95.6%) and perceived risks (94.4%).
Conclusions:
- Esophageal bougienage is a safe, effective, and cost-efficient alternative to endoscopy for pediatric esophageal coin impaction.
- Significant underutilization of bougienage is attributed to insufficient provider education and unfounded concerns about safety and efficacy.
- Increased education on bougienage techniques and further prospective studies are warranted to promote its wider adoption.
Objectives:
The aims of the study are to evaluate outcomes of esophageal bougienage for management of lodged esophageal coins and to assess the extent of bougienage usage and barriers among emergency providers.
Methods:
We performed a retrospective chart review of pediatric patients with single lodged esophageal coins presenting to our single academic pediatric emergency department between November 2012 and December 2018. We compared procedural outcomes, complications, length of stay (LOS), and cost between those managed with bougienage and with endoscopy. We further surveyed emergency physicians to assess the extent of bougienage usage and barriers to utilization across different institutions.
Results:
We identified 205 patients with single lodged esophageal coins presenting during our study window. One hundred forty-seven patients ultimately underwent bougienage with 97% success and no major complications. Fifty-six patients were managed by endoscopy with 100% success and one major complication. Bougienage had significantly lower LOS (median 2.18 vs 11.92 hours, P < 0.001) and hospital charges (median $3533 vs $12,679, P < 0.001) compared with endoscopy. We received 242 completed surveys representing 38 states from primarily academic pediatric emergency physicians. The majority of respondents (90%) used specialist consult with only 4.5% performing bougienage. A total of 36.4% of respondents had never heard of the procedure and only 16.1% had ever performed it. Barriers to usage included lack of provider training (95.6%), perceived risk of complications (94.4%), and perceived lack of success (80.5%).
Conclusions:
Bougienage is safe and effective with significant LOS and cost benefits compared with endoscopy. Despite these advantages, the procedure is underused, because of lack of provider education and concerns regarding safety, efficacy, and both family and specialist preference, which are not supported by current literature. These data support the need for broader education regarding the bougienage technique, as well as larger prospective studies of its safety and outcomes.
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