Original article
Clinical endoscopy
Gastric injury secondary to button battery ingestions: a retrospective multicenter review

Presented at Digestive Disease Week 2019 (Gastrointest Endosc 2019;89:AB283) and at the Annual Meeting for the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.
https://doi.org/10.1016/j.gie.2020.04.037Get rights and content

Background and Aims

Removal of gastric button batteries (BBs) remains controversial. Our aim was to better define the spectrum of injury and to characterize clinical factors associated with injury from retained gastric BBs.

Methods

In this multicenter retrospective cohort study from January 2014 through May 2018, pediatric gastroenterologists from 4 pediatric tertiary care centers identified patients, aged 0 to 18 years, who had a retained gastric BB on radiography and subsequently underwent endoscopic assessment. Demographic and clinical information were abstracted from electronic health records using a standard data collection form.

Results

Sixty-eight patients with a median age of 2.5 years underwent endoscopic retrieval of a gastric BB. At presentation, 17 (25%) were symptomatic. Duration from ingestion to endoscopic removal was known for 65 patients (median, 9 hours [interquartile range, 5-19]). Median time from ingestion to first radiographic evaluation was 2 hours. At endoscopic removal, 60% of cases had visual evidence of mucosal damage, which correlated with duration of BB retention (P = .0018). Time to retrieval of the BB was not statistically significant between symptomatic and asymptomatic subjects (P = .12). After adjusting for age and symptoms, the likelihood of visualizing gastric damage among patients who had BBs removed 12 hours post ingestion was 4.5 times that compared with those with BB removal within 12 hours of ingestion.

Conclusions

In this study, swallowed BBs posed a risk of damage to the stomach, including a single case of impaction and perforation of the gastric wall. Clinicians may want to consider retrieval within 12 hours of ingestion of gastric BBs. Larger prospective studies to assess risk of injury are needed.

Section snippets

Methods

We performed a multicenter retrospective study at 4 tertiary care centers from January 2014 through May 2018 with Institutional Review Board approval from each individual site. This time frame was determined based on the availability of electronic medical records at all participating institutions. Chart review identified cases of endoscopic removal of gastric BBs in patients between 0 and 18 years of age. Cases were identified from the following tertiary care institutions: Children’s Hospital

Results

We identified 68 patients from 4 participating institutions who underwent endoscopic retrieval of gastric BBs (Table 1). Of these, 42 (65%) were boys with a median age of 2.5 years (range, 8 months to 16 years). Twenty-one (31%) had an initial evaluation at an outlying facility before referral to 1 of 4 tertiary care centers included in the study. Specifically, 27 cases were treated at Cincinnati Children’s Hospital, 26 at Texas Children’s Hospital, 8 at Children’s Hospital Colorado, and 7 at

Discussion

This is the largest adult or pediatric case series investigating endoscopic findings and adverse events secondary to gastric retention of BBs to date. These data demonstrate that gastric retention of BBs poses a risk of serious injury. Prior published guidelines from the National Capital Poison Center, last revised in June 2018, recommend immediate removal of a gastric BB only if co-ingested with a magnet or if the patient is symptomatic.9 Otherwise, current guidelines from the Poison Control

References (18)

  • K. Leinwand et al.

    Button battery ingestion in children: a paradigm for management of severe pediatric foreign body ingestions

    Gastrointest Endosc Clin North Am

    (2016)
  • S. Honda et al.

    Severe gastric damage caused by button battery ingestion in a 3-month-old infant

    J Pediatr Surg

    (2010)
  • A.R. Ettyreddy et al.

    Button battery injuries in the pediatric aerodigestive tract

    Ear Nose Throat J

    (2015)
  • D.E. Brumbaugh et al.

    Management of button battery-induced hemorrhage in children

    J Pediatr Gastroenterol Nutr

    (2011)
  • T. Litovitz et al.

    Emerging battery-ingestion hazard: clinical implications

    Pediatrics

    (2010)
  • J. Tanaka et al.

    Esophageal electrochemical burns due to button type lithium batteries in dogs

    Vet Hum Toxicol

    (1998)
  • R.E. Kramer et al.

    Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee

    J Pediatr Gastroenterol Nutr

    (2015)
  • T. Litovitz et al.

    Preventing battery ingestions: an analysis of 8648 cases

    Pediatrics

    (2010)
  • National Capital Poison Control Center

There are more references available in the full text version of this article.

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DISCLOSURE: The following authors received research support for this study from the Cystic Fibrosis Foundational Grant Award (no. Khalaf17B0, HAZLET15B0, and HAZLET18D0) and National Institutes of Health Training Grant 5T32-DK067009-12: R. Khalaf, K. Hazleton; National Institutes of Health Training Grant 5T32-DK7664-28: W. Ruan; National Institutes of Health Training Grant NIH 5T32-DK0077-27: S. Orkin; and Sondheimer Fellow Funds (R. Khalaf) from Childrens Hospital Colorado. In addition, the following author disclosed financial relationships: D. S. Fishman: Paid contributor to UpToDate. All other authors disclosed no financial relationships.

See CME section; p. 404.

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