title: Efficacy of esophageal bougienage by emergency physicians in pediatric coin ingestion.
abstract: OBJECTIVE
  To determine the efficacy and safety of bougienage performed by properly trained pediatric emergency medicine physicians to advance a recently ingested coin lodged in the esophagus into the stomach.
  
  
  METHODS
  We carried out a prospective study of consecutive cases at two university-affiliated pediatric hospitals. Our subjects were 31 children, each with an ingested coin lodged in the esophagus, who met criteria for bougienage: a single coin ingested in the preceding 24 hours, radiographically localized in the esophagus; no history of esophageal disease, esophageal surgery, or foreign body removal; and no sign of respiratory compromise. The bougienage procedure involved a single pass of a Hurst bougie dilator from the mouth to the stomach with the unsedated patient sitting upright.
  
  
  RESULTS
  In all cases, the coin was successfully advanced into the stomach with a single pass of the bougie dilator. No patient experienced an acute complication or delayed surgical complication related to the procedure. In one case the coin was vomited after the procedure and recovered without complications. Mild abdominal pain developed in two patients, who were reevaluated 2 weeks after the procedure. In each case the coin was present in the stomach and was removed endoscopically without subsequent complications.
  
  
  CONCLUSIONS
  When used by trained emergency physicians, esophageal bougienage is a safe, effective, cost-containing treatment for dislodging and advancing ingested coins from the esophagus into the stomach that requires no sedation or general anesthesia.
authors.affiliation: Children's Healthcare St Paul, Minnesota, USA.
authors.forename: H C
authors.initials: HC
authors.lastname: Emslander
authors.forename: W
authors.initials: W
authors.lastname: Bonadio
authors.forename: M
authors.initials: M
authors.lastname: Klatzo
mesh_terms: D002648:Child; D002675:Child, Preschool; D004106:Dilatation / Q000191:economics / Q000295:instrumentation / Q000379:methods; D004632:Emergency Medical Services / Q000191:economics / Q000379:methods*; D004945:Esophagoscopy / Q000191:economics; D004947:Esophagus; D005547:Foreign Bodies / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D011446:Prospective Studies