# Ingestion of Foreign Bodies — GCMD Library living collection

Updated: n/a · 3 episodes · 65 cited statements

## Episodes
### Tools

### In-depth Review
- [Digestive Foreign Bodies: Diagnosis and Management](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776) — podcast · 17:54 · [machine version](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776.md)

### Work-up and Treatment

### Updates
- [Update Course 2021: APSA PDC UPDATES](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412) — video · [machine version](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412.md)
- [Button Battery Ingestion](https://library.globalcastmd.com/watch/button-battery-ingestion-2300) — video · 14:28 · [machine version](https://library.globalcastmd.com/watch/button-battery-ingestion-2300.md)

## Chapters
- [0:01](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=1) Case presentation and initial management of button battery ingestion (Ep 3)
- [2:33](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=153) Complications and follow-up management controversies (Ep 3)
- [4:41](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=281) Epidemiology, pathophysiology, and vascular complications (Ep 3)
- [8:47](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=527) Management of batteries in the stomach and esophageal injury assessment (Ep 3)
- [9:56](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=596) Post-removal surveillance and management of identified injuries (Ep 3)
- [13:09](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=789) Emerging mitigation strategies and operational improvements (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=0) Introduction and Episode Overview (Ep 1)
- [1:39](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=99) Common Locations and Age Groups for Foreign Body Ingestion (Ep 1)
- [4:21](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=261) Types of Ingested Objects and Intervention Rates (Ep 1)
- [5:36](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=336) Clinical Presentation and Physical Examination (Ep 1)
- [7:07](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=427) Imaging Workup and Eosinophilic Esophagitis Considerations (Ep 1)
- [9:11](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=551) Button Battery Management (Ep 1)
- [11:50](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=710) Management of Coins and Sharp Objects (Ep 1)
- [14:45](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=885) Removal Techniques: Rigid vs Flexible Esophagoscopy (Ep 1)
- [16:54](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=1014) Summary and Key Takeaways (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=0) Introduction to APSA PDC and Family-Centered Care (Ep 2)
- [9:12](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=552) Intestinal Rehabilitation and Short Bowel Syndrome Management (Ep 2)
- [22:53](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=1373) Button Battery Ingestion Emergency Management (Ep 2)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Button battery ingestions are becoming more frequent, with national data showing increasing numbers of emergency department visits. — Dan (epidemiological) [Ep 3 · 0:01](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=1)
- Button batteries are ubiquitous in greeting cards, remotes, and similar devices. — Dan (clinical) [Ep 3 · 0:50](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=50)
- A ring around the edge of a circular object on X-ray indicates it is a button battery, not a quarter. — Dan (clinical) [Ep 3 · 1:30](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=90)
- Foley catheter technique may work for button battery removal when operating room access is delayed and symptom duration is short. — Dan (clinical) [Ep 3 · 2:10](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=130)
- NASPGHAN and the GI group developed guidelines for button battery management with zero input from surgeons. — Mark (guideline) [Ep 3 · 3:44](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=224)
- Guidelines mandate serial MRIs for button battery cases due to concern for vascular injury. — Mark (guideline) [Ep 3 · 4:10](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=250)
- 20-25 millimeter batteries are lithium batteries that tend to be 3 volt rather than 1.5 volt. — Dan (clinical) [Ep 3 · 5:30](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=330)
- The pathophysiology is caustic injury from hydroxide ions that rapidly raise tissue pH, not mechanical erosion or electricity. — Dan (clinical) [Ep 3 · 5:45](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=345)
- Complications include esophageal perforation, stricture, tracheoesophageal fistula, and vocal cord paralysis not associated with perforation. — Dan (clinical) [Ep 3 · 6:10](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=370)
- Using trauma one system activation reduced time from door to OR from 1.5 hours to less than 30 minutes. (clinical) [Ep 3 · 8:47](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=527)
- For minor mucosal injury on endoscopy, symptomatic follow-up without intervention is appropriate. — Dan (opinion) [Ep 3 · 10:24](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=624)
- For circumferential erosions that look bad, re-scoping to look for stricture formation is recommended. — Dan (opinion) [Ep 3 · 10:43](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=643)
- If patients become symptomatic after injury, esophagram can assess for narrowing or stricture. — Dan (clinical) [Ep 3 · 10:54](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=654)
- Endoscopy advantage over esophagram is ability to reassess appearance and dilate if needed. — Dan (clinical) [Ep 3 · 11:32](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=692)
- If already performing endoscopy and capable of removing battery from stomach, removal is advocated. — Dan (opinion) [Ep 3 · 12:27](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=747)
- 20-25 millimeter batteries are the ones of most concern. (clinical) [Ep 3 · 13:01](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=781)
- There is evolving work in animal models using 0.25% acetic acid applied to the area of injury to neutralize it. (clinical) [Ep 3 · 13:34](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=814)
- Acetic acid for neutralization is not something off the shelf and requires pharmacy coordination. (clinical) [Ep 3 · 13:58](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=838)
- Esophageal foreign bodies commonly lodge at three sites: high at the cricopharyngeus, where the aorta crosses over (less common), and most commonly at the lower esophageal sphincter. — Vince Mkotta (clinical) [Ep 1 · 2:04](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=124)
- The most common age group for foreign body ingestion is 6 months to 6 years (just mobile infants through toddler age range). — Vince Mkotta (epidemiological) [Ep 1 · 3:29](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=209)
- Foreign body ingestion can occur in very young infants, such as when a toddler tries to feed an infant. — Vince Mkotta (clinical) [Ep 1 · 3:29](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=209)
- Coins are by far the majority of ingested foreign bodies. — Todd (epidemiological) [Ep 1 · 4:23](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=263)
- There has been a rash of issues with magnets where older kids pretend to get piercings by putting magnets across their tongue and swallow them by accident. — Todd (epidemiological) [Ep 1 · 4:23](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=263)
- Many patients with small objects that are likely to pass never reach gastroenterology, as pediatricians appropriately manage them expectantly in asymptomatic children. — Vince Mkotta (clinical) [Ep 1 · 5:04](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=304)
- Symptoms of esophageal foreign bodies include odynophagia (pain with swallowing), intolerance of secretions and drooling, pointing to one spot on the throat (especially in younger children), vomiting after attempting to swallow, chest pain, and refusal to eat in chronic cases. — Vince Mkotta (clinical) [Ep 1 · 5:42](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=342)
- Physical examination findings are usually minimal in patients with digestive foreign bodies. — Vince Mkotta (clinical) [Ep 1 · 6:30](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=390)
- Initial imaging for suspected foreign body ingestion is a two-view abdomen and chest X-ray. — Vince Mkotta (guideline) [Ep 1 · 7:17](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=437)
- The classic teaching that coins in the esophagus appear coronal and coins in the airway appear sagittal is not always the case according to published evidence. — Vince Mkotta (clinical) [Ep 1 · 7:17](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=437)
- For asymptomatic patients with strong suspicion of radiolucent foreign body ingestion not visible on plain X-ray, a contrast study may be performed. — Vince Mkotta (clinical) [Ep 1 · 7:17](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=437)
- Contrast studies should not be performed if suspicion is high and the patient is symptomatic, and contrast can make endoscopic retrieval more difficult. — Vince Mkotta (clinical) [Ep 1 · 7:17](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=437)
- Cross-sectional imaging is very rarely considered for foreign body workup. — Vince Mkotta (clinical) [Ep 1 · 7:17](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=437)
- Eosinophilic esophagitis should be suspected with family history of the condition or frequent food impactions, strong atopic history (food allergy, asthma, severe eczema, rhinitis), or when an object that should have passed becomes lodged in the esophagus. — Vince Mkotta (clinical) [Ep 1 · 8:20](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=500)
- Button batteries are the biggest and most common need for emergent foreign body removal. — Vince Mkotta (clinical) [Ep 1 · 9:19](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=559)
- The double-edged sign (a step-off especially visible on lateral X-ray) is classic for button batteries, though it may not always be visible depending on how long the battery has been present. — Vince Mkotta (clinical) [Ep 1 · 9:19](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=559)
- Witnessed esophageal button batteries are treated as emergencies and taken to the operating room for removal within 2 hours. — Vince Mkotta (guideline) [Ep 1 · 9:19](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=559)
- When concerned about a button battery, imaging should include the whole neck and chest to rule out a more proximal battery that may have been cut off the film. — Vince Mkotta (clinical) [Ep 1 · 10:44](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=644)
- Guidance exists to let asymptomatic patients with gastric button batteries go home, but many practitioners are uncomfortable with this due to fatal gastric button battery ingestions and will retrieve them immediately if reachable. — Vince Mkotta (opinion) [Ep 1 · 11:09](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=669)
- Esophageal foreign bodies are generally retrieved, though there may be an argument for expectant management in bigger asymptomatic kids. — Vince Mkotta (clinical) [Ep 1 · 12:09](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=729)
- Guidance indicates that esophageal foreign bodies present for 24 hours can cause significant problems. — Vince Mkotta (guideline) [Ep 1 · 12:09](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=729)
- For esophageal foreign bodies present for a short time in asymptomatic patients, the patient may be admitted and a repeat X-ray obtained in the morning; if the object has not moved, it should be retrieved. — Vince Mkotta (clinical) [Ep 1 · 12:45](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=765)
- Relatively large foreign bodies (4 or 5 centimeters) in the stomach may not pass the pylorus and have a higher likelihood of requiring retrieval. — Vince Mkotta (clinical) [Ep 1 · 13:21](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=801)
- Round gastric foreign bodies unlikely to cause injury in asymptomatic children are typically allowed to pass and looked for in the stool. — Vince Mkotta (clinical) [Ep 1 · 13:21](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=801)
- Sharp objects with one sharp side that reach the stomach generally pass through the GI tract without significant injury, with the theory that they flip and go blunt side down. — Vince Mkotta (clinical) [Ep 1 · 13:52](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=832)
- Double-headed sharp objects like toothpicks are retrieved if at all possible. — Vince Mkotta (clinical) [Ep 1 · 13:52](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=832)
- Open safety pins are retrieved if reachable. — Vince Mkotta (clinical) [Ep 1 · 13:52](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=832)
- Objects like nails or pins in the stomach are retrieved if reachable, but significant effort is not expended once they pass beyond the stomach; patients are watched for symptoms. — Vince Mkotta (clinical) [Ep 1 · 13:52](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=832)
- When removing an open safety pin, always pull it out with the point facing downward or away; if the point faces the mouth, push it down into the stomach first, then grab and pull it backwards so the blunt side leads. — Todd (clinical) [Ep 1 · 14:51](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=891)
- Very proximal esophageal foreign bodies are very difficult to retrieve with a flexible scope and are preferably removed by surgery or ENT with a rigid scope. — Vince Mkotta (clinical) [Ep 1 · 15:32](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=932)
- Gastroenterology typically uses flexible scopes for all foreign body retrievals. — Vince Mkotta (clinical) [Ep 1 · 15:32](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=932)
- Proximal esophageal foreign bodies can sometimes be removed with a rigid scope or McGill forceps with a protected airway, without needing to place an airway. — Todd (clinical) [Ep 1 · 16:16](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=976)
- The ability to reach distal esophageal foreign bodies with a rigid scope depends on the age and size of the child. — Todd (clinical) [Ep 1 · 16:16](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=976)
- The APSA Professional Development Committee was established approximately five years ago to curate information from journals, blogs, and guidelines — Marjorie Arca (clinical) [Ep 2 · 0:28](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=28)
- The PDC communicates with the American Board of Surgery and provides information for continuous certification — Marjorie Arca (clinical) [Ep 2 · 0:28](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=28)
- Family-centered care reduces ED visits, decreases anxiety in parents and children, reduces length of stay, reduces medical errors, and improves staff satisfaction — Marjorie Arca (clinical) [Ep 2 · 9:12](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=552)
- Family-centered care is cost effective and decreases legal claims and legal expenses — Marjorie Arca (clinical) [Ep 2 · 9:12](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=552)
- Establishing intestinal continuity as soon as possible is imperative because it allows enteral nutrition to start with human milk, which helps with intestinal rehabilitation — Marjorie Arca (clinical) [Ep 2 · 14:10](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=850)
- Intestinal transplantation is becoming less common because centers are getting very good at intestinal rehabilitation — Marjorie Arca (clinical) [Ep 2 · 14:10](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=850)
- The ileocecal valve decreases the occurrence of small bowel bacterial overgrowth, which can impede the ability to increase feeds — Marjorie Arca (clinical) [Ep 2 · 18:31](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=1111)
- The valve may be more of a prognosticator of how much terminal ileum remains rather than being independently important, as recent studies show terminal ileum resection is more relevant than valve presence (clinical) [Ep 2 · 18:31](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=1111)
- PPI should be started right away after massive bowel resection, not just when starting feeds — Marjorie Arca (clinical) [Ep 2 · 19:44](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=1184)
- Timing for intestinal lengthening procedure is considered around one year of age when the intestine is wide enough to perform the procedure and when the patient has stalled on feedings — Marjorie Arca (clinical) [Ep 2 · 19:44](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=1184)
- Lengthening procedures have real concerns about deleterious effects on motility, which can be worse than having a short bowel (opinion) [Ep 2 · 20:53](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=1253)
- Intestinal lengthening procedures are becoming rarer due to improvements in medical therapy and intestinal rehabilitation centers — Marjorie Arca (clinical) [Ep 2 · 20:53](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=1253)
- Button batteries create both an alkali burn and an electrical burn in the esophagus — Marjorie Arca (clinical) [Ep 2 · 26:17](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=1577)
- Button battery ingestion requires immediate transfer to a pediatric center and removal under direct visualization in the operating room — Marjorie Arca (clinical) [Ep 2 · 26:17](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=1577)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The number of ED visits for button battery ingestion has doubled according to Colorado study data. — Dan summarizing the discussion [Ep 3 · 4:41](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=281)
- The rate of significant complications from button batteries has increased almost sevenfold. — Dan summarizing the discussion [Ep 3 · 5:00](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=300)
- 90% of serious outcomes occur with 20-25 millimeter batteries. — Dan summarizing the discussion [Ep 3 · 5:15](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=315)
- Aortoenteric fistula is the most common cause of mortality in the national data bank, accounting for 46% of mortalities. — Dan summarizing the discussion [Ep 3 · 6:35](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=395)
- Another 29% of mortalities involved some sort of vascular compromise. — Dan summarizing the discussion [Ep 3 · 7:00](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=420)
- Aortoenteric fistula can occur up to 2 weeks post-removal of the battery. — Dan summarizing the discussion [Ep 3 · 7:15](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=435)
- Authors of the Colorado paper recommend MRI after battery removal to assess potential impact on surrounding vasculature. — Dan summarizing the discussion [Ep 3 · 7:35](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=455)
- Some authors advocate scoping patients even when battery is in the stomach because patients can have significant esophageal injuries with the battery having passed on. — Dan summarizing the discussion [Ep 3 · 9:28](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=568)
- Poison.gov recommendations say you do not need to scope if the battery is in the stomach. — Mark summarizing the discussion [Ep 3 · 9:56](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=596)
- There is GI literature about removing 20 millimeter batteries from stomach because they may not pass the ileocecal valve. — Dan summarizing the discussion [Ep 3 · 12:50](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=770)
- The majority of ingested foreign bodies eventually make it into the stomach, but emergency removal is most concerning for esophageal foreign bodies. — Rae Hanke summarizing the discussion [Ep 1 · 1:43](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=103)
- Certain batteries are likely to cause esophageal damage within 2 to 6 hours by causing liquefactive necrosis. — Rod summarizing the discussion [Ep 1 · 10:10](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=610)
- If a magnet is ingested, assume there is more than one. — Rod summarizing the discussion [Ep 1 · 16:54](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=1014)
- If magnets pass the pylorus, the patient must be watched to ensure the magnets do not stick to each other in a way that compromises the bowel. — Rod summarizing the discussion [Ep 1 · 16:54](https://library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=1014)
- Factors associated with achieving enteral autonomy include longer residual small bowel, younger age at time of intestinal resection, preservation of the ileocecal valve, diagnosis other than necrotizing enterocolitis, absence of liver disease, and normal gastrointestinal motility — Marjorie Arca summarizing the discussion [Ep 2 · 11:52](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=712)
- Current NASPGHAN and ESPGHAN guidelines recommend starting enteral nutrition and advancing enteral feeding as soon as possible to help with intestinal rehabilitation — Marjorie Arca summarizing the discussion [Ep 2 · 14:10](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=850)
- Human milk (mother's expressed breast milk or donor milk) is associated with fewer days of parenteral nutrition and is protective for the liver — Marjorie Arca summarizing the discussion [Ep 2 · 14:10](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=850)
- Amino acid based formulas have more favorable outcomes than protein hydrolysis formulas when human milk is not available — Marjorie Arca summarizing the discussion [Ep 2 · 14:10](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=850)
- Guidelines recommend using SMOF lipids (four combination lipids of soy, fish oil, olive oil, and medium chain triglyceride oil) for parenteral nutrition as they are protective — Marjorie Arca summarizing the discussion [Ep 2 · 14:10](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=850)
- Omegaven can be used when liver function tests go up and there is evidence of liver dysfunction, but it can decrease the amount of lipids the patient receives — Marjorie Arca summarizing the discussion [Ep 2 · 14:10](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=850)
- After massive small bowel resection, there is reflex hypergastrinemia that impacts feeding tolerance, and PPI or H2 blockers are recommended with strong recommendation and high level of evidence — Marjorie Arca summarizing the discussion [Ep 2 · 14:10](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=850)
- Teduglutide (glucagon-like peptide 2) increases epithelial proliferation and has been approved in children, but outcomes are not as impactful as in adults because outcomes measured are number of hours off TPN rather than days — Marjorie Arca summarizing the discussion [Ep 2 · 14:10](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=850)
- Intestinal lengthening procedures should be delayed for a few months until adaptation starts because this allows more length to be gained from the remaining bowel — Marjorie Arca summarizing the discussion [Ep 2 · 14:10](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=850)
- For button battery ingestion in children greater than 12 months old, give honey 10 ml every 10 minutes while arranging transfer — Marjorie Arca summarizing the discussion [Ep 2 · 26:17](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=1577)
- For button battery ingestion in children less than 12 months old, give sucralfate suspension 1 gram per 10 ml or 10 ml every hour times 3 — Marjorie Arca summarizing the discussion [Ep 2 · 26:17](https://library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412?t=1577)

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