April 11, 2008
When a kid has swallowed a coin and it’s stuck in the throat, it’s safe for emergency physicians or other doctors to use a flexible instrument to push it into the stomach rather than try to pull it up, according to a new report.
With bougienage, as the procedure is called, the goal is to push the coin down so it can then enter the digestive tract and be passed out in the natural course of events. Someone trained in the procedure can insert and withdraw the “bougie” in 5 seconds or less. No anesthesia is necessary, other than perhaps an anesthetic spray applied to the back of the child’s throat.
In many cases, however, an endoscope is inserted into the throat in an effort to grasp the coin and pull it up, according to the report in the Annals of Emergency Medicine. Endoscopy in these circumstances is performed under general anesthesia in the operating room.
To compare the safety and effectiveness of these procedures, a research team led by Dr. Joseph Leo Arms, from the Children’s Hospitals and Clinics of Minnesota in Minneapolis, assessed the outcomes of 620 patients who were treated over a 12 year period at one of their emergency departments for a coin stuck in the esophagus.
The average age of the patients was 3.7 years. Bougienage was used to manage 372 cases while 248 were treated with endoscopy.
Bougienage failed to do the trick for only 17 patients, all of whom were then successfully treated with endoscopy. Endoscopy was successful in all but one patient.
On average, the length of stay with endoscopy was 6.1 hours with an average hospital charge of $6087, whereas with bougienage, the stay was just 2.2 hours at a charge of $1884.
“Although several management options are available, in properly screened patients, bougienage is highly successful and safe and may provide significant savings of time and money,” Arms’ team concludes.
The findings from a large case series indicate that bougienage is a safe and effective alternative to endoscopy for removing coins acutely lodged in the esophagus. Moreover, use of bougienage may markedly reduce the length of stay and hospital charges.
Of 372 treated patients, bougienage was successful in all but 17, the report indicates. No complications occurred in any of the patients