Esophageal foreign bodies in the pediatric population: our first 500 cases.
BACKGROUND
Children with esophageal foreign bodies are frequently seen by pediatric surgeons. Choking and dysphagia are common presentations; however, esophageal perforation has been reported. Historically, rigid esophagoscopy with extraction of the foreign body has been the recommended treatment. Alternatively, Foley balloon extraction is a safe and effective approach.


METHODS
Over a 16-year period, 555 children presented with an esophageal foreign body. Retrospective analysis of the medical record was undertaken. Statistics were by univariate analysis.


RESULTS
Two hundred ninety-eight boys and 257 girls presented with a mean age of 3.24 years. Dysphagia (37%) and drooling (31%) were the most common symptoms. Foreign bodies were lodged in the superior esophagus in 73%, and 88% of the objects were coins. Balloon extraction with fluoroscopy was performed in 468 children. Eighty percent of the objects were successfully removed with a mean fluoroscopy time of 2.2 min, and 8% were advanced into the stomach. The overall success rate was 88%, with failures necessitating rigid esophagoscopy under general anesthesia. Children younger than 1 year were the most likely to fail (25% failure rate). Airway aspiration never occurred. Significant savings in patient charges were observed with this approach.


CONCLUSIONS
Balloon extraction of pediatric esophageal foreign bodies is a safe and cost-effective procedure. This technique is applicable for infants, children, and adolescents. Experienced practitioners should be able to achieve greater than 80% success rate.
Little
Danny C
DC
Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA.
Shah
Sohail R
SR
St Peter
Shawn D
SD
Calkins
Casey M
CM
Morrow
Stephen E
SE
Murphy
J Patrick
JP
Sharp
Ron J
RJ
Andrews
Walter S
WS
Holcomb
George W
GW
Ostlie
Daniel J
DJ
Snyder
Charles L
CL