Clinical effectiveness of bougienage for esophageal coins in a pediatric ED

Evan H Allie; Aaron M Blackshaw; Joseph D Losek; Rachel E Tuuri

doi:10.1016/j.ajem.2014.08.007

Clinical effectiveness of bougienage for esophageal coins in a pediatric ED

Am J Emerg Med. 2014 Oct;32(10):1263-9. doi: 10.1016/j.ajem.2014.08.007. Epub 2014 Aug 7.

Authors

Evan H Allie¹, Aaron M Blackshaw², Joseph D Losek³, Rachel E Tuuri⁴

Affiliations

¹ Medical University of South Carolina Children's Hospital, Department of Pediatrics Residency Program, Charleston, SC.
² Medical University of South Carolina, College of Medicine, Charleston, SC.
³ Medical University of South Carolina Children's Hospital, Department of Pediatrics, Division of Pediatric Emergency Medicine, Charleston, SC.
⁴ Medical University of South Carolina Children's Hospital, Department of Pediatrics, Division of Pediatric Emergency Medicine, Charleston, SC. Electronic address: tuuri@musc.edu.

PMID: 25178851
DOI: 10.1016/j.ajem.2014.08.007

Abstract

Objective: To describe a tertiary care pediatric emergency department (PED) experience with bougienage for esophageal coins.

Methods: This was a large retrospective case series of children with esophageal coins presenting to a tertiary PED from January 2004 to October 2012. Bougienage eligibility criteria were medically stable, no prior gastro-esophageal surgery or disease, single coin, and witnessed ingestion within 24 hours. Abstracted data were age, signs and symptoms, coin type, management, efficacy, complications, returns, length of stay (LOS), and hospital charges. Main outcomes included procedural success and complications. Secondary outcomes included LOS and hospital charges.

Results: There were 245 patients with esophageal coins with 136/145 (94%) successful bougienage procedures and 109/109 (100%) successful surgical retrievals. There were 18 minor complications and 5 return visits for patients with bougienage. There were 10 minor and 2 major complications with surgical retrieval. Patients undergoing bougienage were 4 years (SD 2) vs 3 years (SD 3) for surgical retrieval (P < 0.001). Mean LOS for successful bougienage was 137 minutes (SD 54) vs 769 (SD 535) for surgical retrieval. The difference in the means was 632, 95% CI for the difference in means of -723 to -541 (P < .001). Mean charges for successful bougienage were $984 (SD $576) vs. $7022 (SD $3132) for surgical retrieval. The difference in means was $6038, 95% CI -$6,580 to -$5,496 (P < .001).

Conclusions: Esophageal bougienage is safe and highly effective. It is also more time and cost efficient than other treatment options.

MeSH terms

Age Factors
Child
Child, Preschool
Cohort Studies
Dilatation / methods*
Eating*
Emergency Service, Hospital*
Esophagus*
Female
Foreign Bodies / diagnostic imaging
Foreign Bodies / therapy*
Humans
Infant
Male
Numismatics
Radiography
Retrospective Studies
Treatment Outcome