What is the recommended method for removing a foreign object, such as a quarter, from a child's esophagus?

From the Guidelines

The recommended method for removing a foreign object like a quarter from a child's esophagus is to seek immediate medical attention at an emergency department for urgent endoscopic extraction, as this approach is associated with a low complication rate and high success rate 1. When a child ingests a foreign object, such as a quarter, it is crucial to prioritize prompt medical evaluation to minimize the risk of complications, including esophageal obstruction, perforation, and pressure necrosis.

Key Considerations

• The child should not attempt to remove the object at home, as this can cause further complications, such as pushing the object deeper into the esophagus or causing damage to the esophageal wall.
• Medical professionals will typically use an endoscopic procedure, such as esophagoscopy, to visualize and safely remove the object, with the majority of cases requiring anesthetic input and often a general anesthetic with endotracheal intubation to protect the airway 1.
• In some cases, X-rays may be performed first to confirm the location of the quarter and assess for any potential complications.
• While waiting for medical care, it is essential to keep the child calm and upright if possible, and not give food or drink, as this may complicate the situation.

Endoscopic Extraction

• Urgent endoscopic extraction is recommended for other esophageal foreign bodies without complete obstruction (Grade 1B) 1.
• The use of flexible endoscopy is preferred as the first-line approach for removing foreign bodies from the esophagus, with rigid endoscopy considered as a second-line therapy in certain cases, such as foreign bodies located in the upper esophagus or with concomitant respiratory symptoms 1.
• The endoscopic procedure may involve the use of various techniques, including retrieval with a net, baskets, snares, and grasping forceps, depending on the type and location of the foreign object.

From the Research

Recommended Method for Removing a Foreign Object from a Child's Esophagus

The recommended method for removing a foreign object, such as a quarter, from a child's esophagus depends on the presence of symptoms and the duration of the ingestion.

• If the child is symptomatic (cough, stridor, respiratory distress, drooling, or pain), immediate removal via endoscopy is recommended 2.
• If the child is asymptomatic, current data support expectant management for a period of 12-24 hours with the hope of spontaneous passage and avoidance of general anesthesia and surgical procedure 2.
• Alternatively, bougienage technique can be used to dislodge the esophageal coin into the stomach, which is an effective, safe, and more economic treatment modality for selected pediatric patients with uncomplicated coin ingestion 3.

Considerations for Endoscopic Extraction

• Endoscopic removal is the preferred treatment in many pediatric centers as its safety and effectiveness are well established 3.
• Flexible endoscopy is recommended as the first-line therapeutic option because it can be performed under sedation, is cost-effective, and is well tolerated 4.
• Rigid endoscopy under general anesthesia may be advantageous in some circumstances, but it is less used and should be performed in multidisciplinary centers where expertise is available 4.

Sedation and Anesthesia

• Sedation for endoscopy provides comfort for the patient and better examination conditions for the endoscopist, but it should be targeted for moderate levels of sedation and personnel should be able to avoid and rescue patients from deeper sedation levels 5.
• Formal training, supervision by anaesthesiology staff, and definition of standard operating procedures are necessary to provide proper and safe non-anaesthesiologist sedation for endoscopy 5.