Pediatric Esophageal Button Battery Protocol Reduces Time From Presentation to Removal

Area of Science:

• Pediatric Gastroenterology
• Otolaryngology
• Medical Device Safety

Background:

• Esophageal button battery (BB) ingestion poses a significant risk of severe mucosal injury.
• Timely removal and effective mitigation strategies are crucial to prevent esophageal damage.

Purpose of the Study:

• To evaluate the effectiveness of an institutional protocol (Zakai's Protocol - ZP) in reducing the time to esophageal BB removal.
• To assess the impact of the protocol on the utilization of mitigation strategies.

Main Methods:

• A case-series study reviewed 51 patients with esophageal BB impaction before and after ZP implementation (2011-2023).
• Key metrics included time from institutional arrival to operating room (OR) transfer, adherence to protocol steps, and use of mitigation strategies (honey, sucralfate, acetic acid).

Main Results:

• The time to OR transfer decreased significantly from 4.6 hours to 0.4 hours (p < 0.001) post-ZP implementation.
• Adherence to critical management steps, including direct otolaryngology referral and OR transfer, improved substantially.
• Use of mitigation strategies like preoperative honey/sucralfate and intraoperative acetic acid increased significantly.

Conclusions:

• Zakai's Protocol implementation effectively reduced esophageal BB removal time and enhanced the use of mitigation strategies.
• Further efforts in BB ingestion prevention and optimizing transfer times to tertiary care centers are necessary to minimize erosive complications.