Evaluation of a Symptom-Based Algorithm for Managing Battery Ingestions in Children

Infographic · Apr 2022 · 1 min read

In brief

This retrospective study of 44 pediatric button battery ingestions validates a symptom-based algorithm emphasizing observation over intervention for batteries beyond the gastroesophageal junction. All esophageal batteries required immediate endoscopic removal, while gastric and distal batteries were safely managed conservatively without routine admission or serial imaging.

Esophageal button batteries require immediate endoscopic removal; all 6 cases in this study were appropriately managed with urgent retrieval.
Asymptomatic gastric batteries can be safely observed without admission if they remain in the stomach on repeat imaging per symptom-based protocol.
Batteries beyond the gastroesophageal junction (small bowel/colon) rarely require intervention when patients are asymptomatic—conservative management is safe.
Over-intervention occurred in 23% of gastric battery cases with unnecessary admissions despite asymptomatic presentation and appropriate battery location.
Symptom-focused algorithms reduce unnecessary procedures: 2 of 4 EGDs were performed after batteries had already migrated past the stomach naturally.

Written by the GCMD Library team from the infographic.

The infographic features a central X-ray image of a child's torso showing battery locations in the esophagus, stomach, small bowel, and colon with percentage labels. Two decision pathways flank the image: a red pathway on the left for symptomatic cases requiring endoscopic removal, and a blue pathway on the right for asymptomatic cases beyond the gastroesophageal junction recommending conservative management. A data box in the lower left shows study details from Kansas, USA.

Objectives: While complications from battery ingestion can be severe, especially with the emergence of stronger battery elements, not all ingestions require prompt removal. We aim to evaluate a symptom-focused algorithm for battery ingestion that emphasizes observation over intervention to investigate its safety.

Materials and methods: Patients were identified through a query of foreign-body ingestion radiographs obtained between 2017 and 2020. A retrospective chart review was then performed of all patients who presented with button battery ingestions to identify compliance with our algorithm, overall outcomes, and complications.

Results: In total, 2% of all radiographs (44/2,237) demonstrated button battery ingestions. The median age of patients was 3.8 years (interquartile range, 2.6-5.3). Most batteries were found in the stomach (64%, n = 28), but were also identified in the esophagus (14%, n = 6), small bowel (14%, n = 6), and colon (9%, n = 4). All esophageal batteries were managed with immediate endoscopic retrieval. Ten gastric batteries were not managed per protocol, with seven admitted for observation despite being asymptomatic and repeat abdominal X-rays demonstrating persistent gastric location of the battery. Four patients underwent esophagogastroduodenoscopy; however, in two patients the battery had migrated past the stomach prior to intervention. All small bowel batteries and three of four asymptomatic colon batteries were managed per protocol; one patient had additional imaging that demonstrated battery passage.

Conclusion: Adherence to a symptom-focused protocol for conservative management of button battery ingestions beyond the gastroesophageal junction is safe and frequently does not require admission, serial imaging, or intervention.

The text in the image

Read it at the source ↗