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A safe and cost-effective protocol for the management of esophageal coins in children
J E Kelley1, M H Leech, M G Carr
1Department of Surgery, University of Tennessee College of Medicine-Chattanooga Unit, T.C. Thompson Children's Hospital, Chattanooga.
Insights
Foley balloon extraction and esophageal bougienage are safe, cost-effective methods for managing esophageal coins in children. This approach significantly reduces costs compared to endoscopic removal, offering a valuable protocol for pediatric care.
Area of Science:
- Pediatric Gastroenterology
- Emergency Medicine
- Otolaryngology
Background:
- Esophageal foreign bodies, particularly coins, are common in children.
- Existing management methods for esophageal coins vary.
- A need exists for a safe and cost-effective management protocol.
Purpose of the Study:
- To retrospectively review institutional experience with esophageal coin management over 4 years.
- To establish a safe and cost-effective protocol for pediatric esophageal coin management.
- To compare the efficacy and cost of endoscopic removal versus non-endoscopic methods.
Main Methods:
- Retrospective review of 57 pediatric patients managed for esophageal coins (January 1987 - December 1990).
- Comparison of endoscopic removal (n=19) versus Foley balloon extraction or esophageal bougienage (n=38).
- Analysis of patient costs, effectiveness, and complications for each method.
Main Results:
- Both endoscopic and non-endoscopic methods were 100% effective with no complications.
- Mean patient cost for endoscopic removal was $1,982 vs. $149 for Foley balloon/bougienage.
- 16 patients managed endoscopically could have safely used the less expensive non-endoscopic methods, saving $1,833 per patient.
Conclusions:
- Foley balloon extraction and bougienage are safe and cost-effective for selected pediatric patients with esophageal coins.
- Implementing rigid selection criteria for non-endoscopic removal can lead to significant cost savings.
- A protocol for managing children with esophageal coins using these techniques is proposed.
Abstract:
Foreign bodies of the esophagus are a common problem in children, with the majority of these foreign bodies being coins. Because there are various methods for managing esophageal coins, we retrospectively reviewed our experience of the past 4 years to establish a safe and cost-effective protocol for their management. From January 1987 to December 1990, 57 children were managed for esophageal coins in our institution. Nineteen children were managed endoscopically under general anesthesia, with a mean patient cost of $1,982 (excluding the surgeon and anesthesiologist charge). Thirty-eight children were managed with Foley balloon extraction or esophageal bougienage in the emergency department with a mean patient cost of $149 (excluding surgeon charge). Both methods were 100% effective, and there were no complications in either group. Rigid criteria were used in selecting patients for balloon extraction and bougienage. These were: (1) duration less than 24 hours; (2) no respiratory distress; and (3) no history of esophageal disease or surgery. Using these criteria, 16 of the 19 patients managed endoscopically could have safely and effectively been managed in the emergency department with a net savings of $1,833 per patient. We conclude that Foley balloon extraction and bougienage of esophageal coins in selected children is both safe and cost-effective. A protocol for managing children with esophageal coins is presented, and the techniques of Foley balloon extraction and esophageal bougienage are reviewed.