Evaluating the management timeline of tracheoesophageal fistulas secondary to button batteries: A systematic review

Nicolas S Poupore; Michael C Shih; Shaun A Nguyen; Emily A Brennan; Clarice S Clemmens; Phayvanh P Pecha; Lucas A McDuffie; William W Carroll

doi:10.1016/j.ijporl.2022.111100

Evaluating the management timeline of tracheoesophageal fistulas secondary to button batteries: A systematic review

Int J Pediatr Otorhinolaryngol. 2022 Jun:157:111100. doi: 10.1016/j.ijporl.2022.111100. Epub 2022 May 3.

Authors

Nicolas S Poupore¹, Michael C Shih², Shaun A Nguyen³, Emily A Brennan⁴, Clarice S Clemmens³, Phayvanh P Pecha³, Lucas A McDuffie⁵, William W Carroll³

Affiliations

¹ Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA; University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA. Electronic address: poupore@musc.edu.
² Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
³ Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA.
⁴ Medical University of South Carolina, Department of Research and Education Services, Medical University of South Carolina Libraries, 171 Ashley Avenue, Charleston, SC, 29425, USA.
⁵ Medical University of South Carolina, Department of Surgery, 96 Jonathan Lucas Street, Charleston, SC, 29425, USA.

PMID: 35523610
DOI: 10.1016/j.ijporl.2022.111100

Abstract

Introduction: During the SARS-CoV-2 pandemic, the incidence of pediatric button battery (BB) ingestions has risen. Children have spent more time at home from school, while many parents try to balance working from home and childcare. Additionally, the amount of electronics powered by BB has increased. Tracheoesophageal fistula (TEF) secondary to a retained aerodigestive BB is a devastating development. Management is challenging, and the clinical timeline of watchful waiting versus surgical intervention for TEF is poorly defined in the literature.

Methods: In accordance with PRISMA guidelines, databases searched include PubMed, Scopus, and CINAHL from database date of inception through August 13, 2021. All study designs were included, and no language, publication date, or other restrictions were applied. Case series and reports of TEFs secondary to BBs were included. Clinical risk factors and outcomes were compared between the spontaneous closure and surgical repair groups.

Results: A total of 79 studies with 105 total patients were included. Mortality was 11.4%. There were 23 (21.9%) TEFs that spontaneously closed and 71 (67.6%) that underwent surgical repair. Median time to spontaneous closure compared to surgical repair was significantly different (8.0 weeks [IQR 4.0-18.4] vs. 2.0 weeks [IQR 0.1-3.3], p<0.001). Smaller TEFs were more likely to spontaneously close versus being surgically repaired (9.3 mm ± 3.5 vs. 14.9 mm ± 8.3, p=0.022). Duration of symptoms before BB discovery, BB size, time between BB removal and TEF discovery, and location of the TEF were not statistically different between the spontaneous closure and surgical repair groups.

Conclusion: A TEF secondary to BB ingestion is a potentially deadly complication. Timing of reported TEF spontaneous closure varies significantly. While smaller TEFs may be amenable to healing without surgical repair, no other significant factors were identified that may be associated with spontaneous closure. If clinical status permits, these data suggest a period of observation of at least 8 weeks prior to surgical intervention may be practical for many BB-induced TEFs.

Keywords: Button battery; Spontaneous closure; Surgical repair; Tracheoesophageal fistula.

Publication types

Systematic Review

MeSH terms

COVID-19*
Child
Electric Power Supplies / adverse effects
Humans
Retrospective Studies
SARS-CoV-2
Tracheoesophageal Fistula* / etiology
Tracheoesophageal Fistula* / surgery