Esophageal mucosal changes in children with an acutely ingested coin lodged in the esophagus

An important factor in choosing the method to remove an ingested coin lodged in the esophagus (endoscopy with forceps extraction, Foley catheter extraction, or bougienage advancement) is the duration of the ingestion and the risk for compromise to the esophageal mucosal integrity. We reviewed 50 consecutive cases occurring during a five-year period of children with a witnessed acutely ingested coin (less than 24 hours duration) that was lodged in the esophagus to determine the degree of compromise of the esophageal mucosal integrity. All coins were removed by endoscopic forceps extraction, with direct inspection of esophageal mucosa. The duration of ingestion was less than eight hours in 22 patients, nine to 16 hours in 16 patients, and 17 to 24 hours in 12 patients. Endoscopy showed that the esophageal mucosa had no abnormalities in 42 patients, "minimal erythema" in six patients, and "minimal abrasion" in two patients. There were no symptoms or complications referable to the gastrointestinal tract reported subsequent to coin removal in any case. Ingested coins that are lodged in the esophagus for fewer than 24 hours do not cause significant compromise to the integrity of the esophageal mucosa. We discuss the implications of these findings in the context of choosing an appropriate method for removing esophageal coins.