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Bougienage Versus Endoscopy for Esophageal Coin Removal in Children

Dahshan, Ahmed H., MD, FAAP; Kevin Donovan, Gerard, MD, FAAP

Journal of Clinical Gastroenterology: May-June 2007 - Volume 41 - Issue 5 - p 454-456
doi: 10.1097/01.mcg.0000225622.09718.5f
Alimentary Tract: Clinical Research
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Background Foreign body ingestion is a common pediatric problem. Coins are by far the most common ingested foreign bodies. When ingested coins become lodged in the esophagus, they may cause serious complications if they are not removed in a timely manner. Endoscopic removal is the preferred treatment in many pediatric centers as its safety and effectiveness are well established.

Objectives We performed this study to evaluate safety and effectiveness of an alternative method of managing esophageal coins, using bougienage technique.

Methods Previously healthy children presenting to the local emergency room with uncomplicated, witnessed coin ingestion of less than 24 hours duration were prospectively recruited with an intent-to-treat analysis. A single oral passage of a Hurst bougie dilator was performed by a gastroenterologist to dislodge the esophageal coin into the stomach. If bougienage was successful (x-ray showing coin in the stomach), patients were discharged and instructions were given for monitoring stools until passage of the coin through anus was confirmed. If bougienage was unsuccessful, the child developed symptoms at any time or if a coin remained intragastric for 4 weeks, endoscopic removal was planned. Children whose parents declined to participate in the bougienage treatment received the standard endoscopic removal and their hospital records were used as controls.

Results A total of 10 children were enrolled in this study, with a mean age of 3.2 years (11 mo to 10 y), 6 boys and 4 girls. All received little or no sedation. Nine children (90%) were successfully treated using bougienage, all of whom spontaneously passed the ingested coins, with a mean duration of 2.6 days (1 to 7 d) without subsequent intervention. A single case failed bougienage and underwent endoscopic removal. Three children declined bougienage treatment and underwent endoscopic removal. There were no reported minor or major adverse events with any of our cases. The mean health care cost for the hospital visit for bougienage treatment was $1210, compared with $3100 for the endoscopic removal (P<0.001). Furthermore, the mean time spent in the hospital from diagnosis to discharge was 2 hours for bougienage-treated patients compared with 8 hours for endoscopic treatment (P<0.001).

Conclusions Bougienage of impacted esophageal coins is an effective, safe, and more economic treatment modality for selected pediatric patients with uncomplicated coin ingestion. This simple technique may provide a valuable tool to emergency room physicians or primary care doctors especially when endoscopy is not readily available.

Division of Pediatric GI and Nutrition, University of Oklahoma College of Medicine, Tulsa, OK

There was no outside support provided to the investigators in this study from pharmaceutical or industry sources.

Reprints: Ahmed Dahshan, MS, FAAP, Division of Pediatric GI and Nutrition, University of Oklahoma College of Medicine, Tulsa, 4502 East 41st Street, Tulsa, OK 74135 (e-mail: adahshan@pol.net).

Received for publication April 5, 2006; accepted July 3, 2006

© 2007 Lippincott Williams & Wilkins, Inc.