Annals of Emergency Medicine
Volume 51, Issue 4 , Pages 367-372, April 2008

Safety and Efficacy of a Protocol Using Bougienage or Endoscopy for the Management of Coins Acutely Lodged in the Esophagus: A Large Case Series

  • Joseph Leo Arms, MD

      Affiliations

    • Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN
    • University of Minnesota, Department of Pediatrics, Minneapolis, MN
    • Corresponding Author InformationAddress for reprints: Joseph Leo Arms, MD, 4501 Garfield Ave S, Minneapolis, MN 55419; 612-825-1770, fax 612-813-6484
    • ,
  • Mary Diane Mackenberg-Mohn, PhD, CNP

      Affiliations

    • Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN
    • ,
  • Mariya V. Bowen, PNP, ACPNP

      Affiliations

    • Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN
    • ,
  • Marydee C. Chamberlain, MD

      Affiliations

    • Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN
    • University of Minnesota, Department of Pediatrics, Minneapolis, MN
    • ,
  • Thomas M. Skrypek, MD

      Affiliations

    • University of Minnesota, Department of Pediatrics, Minneapolis, MN
    • ,
  • Manu Madhok, MD, MPH

      Affiliations

    • Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN
    • University of Minnesota, Department of Pediatrics, Minneapolis, MN
    • ,
  • Jose M. Jimenez-Vega, MD

      Affiliations

    • MD Universidad de Ciencias Medicas, San Jose, Costa Rica.
    • ,
  • William A. Bonadio, MD

      Affiliations

    • Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN

Received 23 May 2007; received in revised form 29 August 2007; accepted 6 September 2007. published online 15 October 2007.

Study objective

We report our experience using the bougienage procedure in the management of esophageal coins.

Methods

Observational case series of all patients presenting to our emergency departments with coins acutely lodged in the esophagus between 1994 and 2006. All patients were treated according to our protocol with either endoscopy or bougienage. Patients are eligible for bougienage if they have had a witnessed coin ingestion less than 24 hours before presentation and if esophageal coin position is confirmed by chest radiograph and there is no history of esophageal disease, surgery, or foreign body. Primary outcomes measured were complications, efficacy of procedure, hospital charges, length of stay, and return to the hospital. Length of stay and hospital charges data were gathered for patients presenting in the final 24 months of the study.

Results

Six hundred twenty patients were identified as having esophageal coins. Three hundred fifty-five patients had a successful bougienage, and 17 patients had unsuccessful bougienage. By comparison, 248 patients underwent endoscopy, and the coin was successfully removed in all but 1 of these patients. Of patients undergoing endoscopy, 89 were eligible for bougienage, but patient, parent, or physician preference was for endoscopic management. Eleven patients required reevaluation or readmission for complaints related to esophageal coin. The only complication was subglottic edema, causing respiratory distress in a single patient who had undergone endoscopy. Patients undergoing endoscopy had an average length of stay of 6.1 hours and average hospital charges were $6,087. Patients undergoing bougienage had an average length of stay of 2.2 hours and average hospital charges of $1,884.

Conclusion

In properly screened patients with coins acutely lodged in the esophagus, bougienage offers a safe and effective alternative to other methods of coin management.

 

 Supervising editor: Steven M. Green, MD

 Author contributions: JLA was responsible for literature review and study design, abstractor recruitment and training, and abstract submission and was the author of the article and all other databases and documents associated with this project. JLA, MDM-M, MVB, MCC, TMS, MM, JMJ-V, and WAB were responsible for chart abstraction. JLA, MCC, and WAB edited the article. WAB was the project supervisor. JLA takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that may create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Publication dates: Available online October 15, 2007.

PII: S0196-0644(07)01508-9

doi:10.1016/j.annemergmed.2007.09.001

Refers to article:

  • Esophageal Coin Ingestion: Going Low Tech , 21 January 2008

    Gregory P. Conners
    Annals of Emergency Medicine April 2008 (Vol. 51, Issue 4, Pages 373-374)

Annals of Emergency Medicine
Volume 51, Issue 4 , Pages 367-372, April 2008