Overview
Esophageal body webs, often caused by chronic embedded objects like coins, refer to the formation of fibrous tissue encapsulating a foreign body within the esophageal wall, complicating removal. 6Diagnosis
Clinical History: Less reliable for distinguishing between coins and button batteries; history alone had low accuracy (12.35% for button batteries) 1.
Radiographic Imaging: Highly accurate for diagnosing button batteries (97% negative predictive value) but less critical for coins 1.
Endoscopy: Effective for visualizing and removing sharp foreign bodies like fish bones and chicken bones, primarily lodged in the upper esophagus 5.Management
Coin Removal: Emergency physicians can successfully remove esophageal coins using forceps, often with rapid sequence intubation; succinylcholine and etomidate are commonly used 4.
Button Battery Removal: Preoperative interventions include pH-neutralizing agents like honey or sucralfate within 12 hours, followed by postoperative irrigation with 0.25% acetic acid 2.
Endoscopic Techniques: Flexible or rigid endoscopy is effective for removing most dietary foreign bodies, with caution advised for sharp objects to prevent complications 5.
Special Techniques: Laparoscopic cautery hooks may be necessary for deeply embedded objects unresponsive to conventional forceps 6.Special Populations
Pediatrics: Emergency physicians can manage esophageal coin removals effectively, though complications like minor bleeding and hypoxia should be anticipated 4.
Button Battery Ingestion: Pediatric cases require urgent surgical intervention guided by radiographic findings due to rapid tissue necrosis risks 12.Key Recommendations
Radiographic Imaging should be prioritized for suspected button battery ingestion to guide urgent surgical intervention due to high accuracy in diagnosis (Evidence: Strong 1).
Preoperative Use of pH-Neutralizing Agents such as honey or sucralfate within 12 hours and postoperative irrigation with 0.25% acetic acid is recommended for button battery cases to mitigate tissue injury (Evidence: Moderate 2).
Endoscopic Removal is effective for most esophageal foreign bodies, particularly sharp objects like fish bones, with careful attention to the upper esophagus to avoid complications (Evidence: Moderate 5).
Rapid Sequence Intubation should be considered for pediatric patients undergoing esophageal coin removal to ensure airway safety (Evidence: Expert opinion 4).References
1 Torrecillas V, Meier JD. History and radiographic findings as predictors for esophageal coins versus button batteries. International journal of pediatric otorhinolaryngology 2020. link
2 Hoagland MA, Ing RJ, Jatana KR, Jacobs IN, Chatterjee D. Anesthetic Implications of the New Guidelines for Button Battery Ingestion in Children. Anesthesia and analgesia 2020. link
3 Poorten K. A portal to better governance. Trustee : the journal for hospital governing boards 2011. link
4 Bhargava R, Brown L. Esophageal coin removal by emergency physicians: a continuous quality improvement project incorporating rapid sequence intubation. CJEM 2011. link
5 Lin HH, Lee SC, Chu HC, Chang WK, Chao YC, Hsieh TY. Emergency endoscopic management of dietary foreign bodies in the esophagus. The American journal of emergency medicine 2007. link
6 Knight PJ. Hooking a chronically embedded esophageal coin. Journal of pediatric surgery 2004. link
7 Buenting JE, Spencer EB, Holmes DK. Internet image database: development and implementation. Studies in health technology and informatics 1997. link
8 Kirks DR. Fluoroscopic catheter removal of blunt esophageal foreign bodies. A pediatric radiologist's perspective. Pediatric radiology 1992. link
9 McGuirt WF. Use of Foley catheter for removal of esophageal foreign bodies. A survey. The Annals of otology, rhinology, and laryngology 1982. link