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Pediatric Otolaryngology

(107) Comparison of Non-Operative Management of Esophageal Foreign Bodies

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • JP

    Jacline Phillips, MD

    PGY-5, Chief Resident
    Wake Forest Baptist Medical Center
    Winston Salem, North Carolina, United States

    • Co-Author(s)

  • LH

    Lauren Himes, MD

    Wake Forest Baptist Medical Center, NC, USA

  • Torrey L. Fourrier, MD

    Developing Otolaryngology trainees’ Perceptual Awareness of Neurological Voice Disorders
    University of Utah Health
    Winston Salem, North Carolina, USA

  • JM

    James W. Mims, MD

    Associate Professor
    Wake Forest Baptist Medical Center
    Winston Salem, North Carolina, United States

  • DK

    Dan J. Kirse, MD

    Vice Chair, Professor
    Wake Forest University School of Medicine
    Winston Salem, NC, USA

    • Senior Author(s)

  • EP

    Eleanor Pitz Kiell, MD

    Wake Forest Baptist Medical Center, USA

Disclosure(s):
Jacline Phillips, MD: No relevant relationships to disclose.
James W. Mims, MD: No relevant relationships to disclose.


Introduction: Pediatric esophageal foreign bodies can be managed with operative or non-operative interventions, which include IV glucagon, observation, and oral peanut butter ingestion. The relative efficacy of management strategies and clinical indicators favoring a particular approach are not well-studied. This study evaluates the outcomes of non-operative methods for management of pediatric esophageal coins.

Methods: This is a retrospective study of patients less than 18 years old who presented to a tertiary care center pediatric emergency department with esophageal coin ingestion from January 1, 2012 to December 31, 2020. The following non-operative interventions were analyzed: (1) observation, (2) IV glucagon administration (3) and oral ingestion of peanut butter. Demographic and clinical attributes (ie, time since ingestion, coin location within the esophagus) were collated. Predictive modeling was used to determine patient characteristics favoring non-surgical versus surgical intervention.

Results: During the study period, 229 encounters for confirmed pediatric esophageal coins were identified. Of these, 142 cases were taken immediately for esophagoscopy and removal. Most patients who underwent initial non-operative management went on to have esophagoscopy: 40/46 (87%) who underwent observation alone and 16/24 (66%) who underwent intravenous glucagon. However, in those who were administered oral peanut butter 0/6 (0%) required subsequent esophagoscopy. Esophagoscopy and removal was required for 99% of children age less than 4 years old, presenting greater than 6 hours after ingestion, and coin location above the aortic arch.

Conclusions: Interventions of glucagon and observation alone were not significantly associated with a decreased need for surgical removal of an esophageal coin. The consumption of peanut butter resulted in a significant decrease in esophagoscopy, though this was a small cohort (n=6). Predictive modeling showed that non-operative interventions were only successful in patients over 4 years old presenting within 6 hours of ingestion and a coin below the aortic arch.