Related Experiment Video
Updated: Jul 9, 2025
Author Spotlight: Advancing Biopsy Techniques with Transesophageal Ultrasound
Published on: November 21, 2023
Anatomic Considerations of esophageal button battery ingestion for outcomes and imaging
William G Cohen1, Moira Mchugh2, Terri Giordano2
1Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
Insights
Button battery (BB) ingestion in children most often impacts the cervical esophagus, leading to severe injury and stenosis, particularly in younger patients. Complications are best detected through clinical indication rather than routine surveillance.
Area of Science:
- Pediatric Gastroenterology
- Otolaryngology
- Emergency Medicine
Background:
- Button batteries (BB) pose significant risks of morbidity and mortality in young children.
- Limited data exists on the relationship between esophageal impaction location and patient outcomes or the necessity of surveillance imaging.
Purpose of the Study:
- To investigate the association between the location of button battery impaction in the esophagus and patient outcomes.
- To determine the effectiveness of surveillance imaging in detecting complications.
Main Methods:
- Retrospective chart review of patients treated for button battery ingestion at a single institution from 2018 to 2022.
- Analysis of button battery location, patient demographics, injury severity (Zargar Mucosal Injury Grade), and complication development.
Main Results:
- Cervical esophageal impaction (50%) was most common, occurring in younger children and associated with more severe mucosal injury (80% ≥Grade IIIB).
- Persistent esophageal stenosis occurred in 60% of patients with cervical impaction.
- Complications were primarily detected via clinically indicated evaluations, not routine surveillance (only 5% detected routinely).
Conclusions:
- Cervical button battery impaction in children is linked to younger age, increased injury severity, and a higher risk of stenosis.
- Clinically indicated follow-up is more effective for detecting serious complications than routine surveillance imaging.
Introduction:
Button batteries (BB) are a source of significant morbidity and mortality in young children. Little data is available regarding associations between esophageal impaction location and outcomes or need for surveillance imaging.
Methods:
All patients treated at a single institution following BB ingestion between 2018 and 2022 were included for retrospective chart review.
Results:
Twenty patients were treated at our institution BBs were located, or most significant damage observed, in the cervical esophagus (n = 10, 50 %), followed by thoracic esophagus (n = 6, 30 %), and abdominal esophagus (n = 4, 20 %). Patients with cervical esophageal impaction were younger (482 [370-866] days), than those with thoracic (1395 [871-2369] days) or abdominal esophageal impaction (2021.5 [1230.5-3419.5] days) (p = 0.003). Zargar Mucosal Injury Grade was significantly more severe in patients with cervical button battery impaction; 8/10 (80 %) had a ≥Grade IIIB injury, compared to 2/6 (33.3 %) thoracic impactions and 0/4 (0 %) abdominal impactions (p = 0.002). All patients who developed persistent esophageal stenosis (n = 6) had cervical battery impactions (6, 60 %, p = 0.015). Both TEFs (2/2) had anterior facing anode, while both (2/2) esophageal perforations had posterior. Only 1/20 (5 %) patients, and 1/7 (14.3 %) with serious complications, had a serious complication detected on routine, rather than clinically indicated follow-up surveillance.
Conclusions:
In our population, cervical BB impaction occurred more frequently in younger children, was associated with more severe mucosal injury, and had higher risk of stenosis. Nearly all complications were detected on clinically indicated rather than postoperative surveillance imaging.
Related Concept Videos
01:29Endoscopic Procedures I: Esophagogastroduodenoscopy
During an EGD, the endoscope can be used to:
01:24Upper GI Series: Barium Swallow
Purpose and Procedure
Patients undergoing this procedure ingest a liquid containing barium sulfate with a chalky...
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:30Esophageal Strictures-I: Introduction
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
01:28Endoscopic Procedures III: Video Capsule Endoscopy