SELECTIVE MANAGEMENT OF PEDIATRIC ESOPHAGEAL FOREIGN-BODIES

Esophageal foreign body is a relatively common consultation from the P ediatric Emergency Room. This study evaluates optimal selective manage ment of esophageal foreign bodies in the pediatric patient. Eighty-six children have been referred for esophageal foreign body. Fifteen had been symptomatic for 48 or more hours before being seen. In eight, the re was a known history of previous repair for esophageal atresia. In 8 8%, the foreign body was opaque, most frequently a coin. The most comm on nonopaque foreign body was retained food. Upon diagnosis, 72 childr en were taken to radiology, where balloon extraction under fluoroscopi c control was attempted. Fourteen children went directly to the operat ing room for endoscopy and foreign body removal. Balloon extraction wa s successful in 62 cases (86%), and the children were discharged direc tly from the Emergency Department. The foreign body was successfully r emoved at esophagoscopy in the 10 cases that failed attempts at balloo n extraction. Since 1990, successful extraction has been accomplished in 100% of cases (29/29). Neither balloon extraction nor endoscopy was associated with morbidity or mortality. Endoscopy was, however, assoc iated with total hospital charges approximately 400% higher than ballo on extraction. Fluoroscopically guided balloon extraction of appropria te esophageal foreign bodies is a safe and cost-effective alternative to endoscopy. Failure of nonoperative management does not complicate s ubsequent endoscopic removal. Patients with symptoms > 48 hours, a his tory of prior esophageal atresia, and/or nonopaque esophageal foreign bodies do not preclude attempt at balloon extraction.