Management of a 1 cm Button Battery in the Stomach
Urgent endoscopic removal (within 24 hours) is recommended for a 1 cm button battery located in the stomach, even in asymptomatic patients, due to risk of severe gastric mucosal damage.
Rationale for Urgent Intervention
Button battery ingestion represents a medical emergency requiring prompt management due to several factors:
Button batteries can cause severe damage through multiple mechanisms:
- Direct pressure necrosis
- Electrical burns
- Chemical injury from leaking alkaline contents
The 2019 WSES guidelines recommend emergent flexible endoscopy (preferably within 2 hours, at latest within 6 hours) for batteries due to these risks 1.
While esophageal impaction has traditionally been considered more dangerous, recent evidence shows that gastric location can also cause significant harm:
Management Algorithm
Initial Assessment
- Confirm battery location with immediate X-ray imaging
- Determine battery size, type, and voltage if possible
- Assess for symptoms (vomiting, abdominal pain, hematemesis)
Timing of Intervention
- For 1 cm button battery in stomach:
- Perform endoscopic removal within 24 hours, even in asymptomatic patients
- Consider more urgent removal (within 2-6 hours) if lithium battery (3V) or if patient is symptomatic
- For 1 cm button battery in stomach:
Endoscopic Procedure
- Flexible endoscopy is the preferred approach
- Use retrieval techniques with baskets, snares, or grasping forceps as appropriate
- Carefully examine gastric mucosa for evidence of damage after battery removal
Post-Procedure Management
- Monitor for delayed complications
- Consider follow-up endoscopy if significant mucosal damage was observed
Important Considerations
Battery voltage is a critical factor: lithium batteries (≥1.5 cm, 3V) are associated with moderate to major complications even when located in the stomach 3.
The traditional approach of watchful waiting for batteries in the stomach may be inadequate, as studies show that gastric mucosal damage can occur within hours of ingestion 4.
Lack of symptoms does not rule out significant injury - multiple studies document severe gastric erosions in asymptomatic children 2, 3.
The size of the battery (1 cm) is smaller than the 2 cm threshold traditionally used for intervention, but recent evidence suggests that even smaller batteries can cause significant damage, particularly if they are lithium batteries 3.
Pitfalls to Avoid
- Do not delay intervention based on absence of symptoms, as mucosal damage can occur silently
- Do not assume gastric location is safe - this is an outdated concept
- Do not wait for spontaneous passage if the battery is in the stomach, as damage can occur rapidly
- Do not forget to examine for mucosal injury during endoscopy, as this will guide further management
The evidence strongly supports urgent endoscopic removal of button batteries in the stomach, as this approach minimizes the risk of potentially serious complications including gastric erosions, ulceration, and perforation.