Objective: Evaluate implementation of an institutional protocol to reduce the time to removal of esophageal button battery (BB) and increase use of mitigation strategies.
Methods: We developed a protocol for esophageal BB management [Zakai's Protocol (ZP)]. All cases of esophageal BB impaction managed at a tertiary care center before and after implementation from 2011 to 2023 were reviewed. Time to BB removal, adherence to critical steps, and use of mitigation strategies (honey/sucralfate, acetic acid) were evaluated.
Results: Fifty-one patients (38 pre-ZP, 13 post-ZP) were included. Median age was 2.3 years (IQR 1.3-3.4). After implementation, the time from arrival at the institution to arrival in the operating room (OR) reduced by 4.2 h [4.6 h (IQR 3.9-6.5) to 0.4 h (IQR 0.3-0.6), p < 0.001] and there was improvement in all management steps. The number of referrals direct to otolaryngology increased from 51% to 92%, arrival notification increased from 86% to 100%, avoidance of second x-ray increased from 63% to 100%, and direct transfer to OR increased from 92% to 100%. Adherence to mitigation strategies such as preoperative administration of honey or sucralfate increased from 0% to 38%, intraoperative use of acetic acid from 3% to 77%, and nasogastric tube insertion from 53% to 92%.
Conclusion: Implementation of ZP substantially reduced the time to BB removal and the use of mitigation strategies in our tertiary care institution. Additional strategies focused on prevention of BB ingestion, and shortening the transfer time to the tertiary care hospital are required to prevent erosive complications.
Level Of Evidence: 3, Case-series Laryngoscope, 134:5170-5177, 2024.
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http://dx.doi.org/10.1002/lary.31607 | DOI Listing |
Paediatr Int Child Health
December 2024
Department of Anaesthesiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China.
Background: Impaction of button batteries (BB) in children is not rare.
Aim: To conduct a systematic review of reports of oesophageal injury caused by impaction of BB in children in China.
Methods: The databases of Wanfang, VIP, China National Knowledge Internet, the Chinese Medical Association Journal and PubMed were searched for reports by Chinese authors of BB impaction published between May 2005 and July 2023.
Cureus
November 2024
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.
Cureus
October 2024
Vascular Surgery, The Jikei University School of Medicine, Tokyo, JPN.
BMC Pediatr
November 2024
The Seventh Affiliated Hospital of Southern Medical University, Foshan, Guangdong, 528244, China.
Background: Since children have strong desire for exploration and poor safety awareness, foreign body impaction in the digestive tract is one of the most common critical conditions in children. Due to the popularity of electronic products, button battery ingestion by mistake is also increasing in children. Button battery impaction in the esophagus can cause serious complications such as esophageal cauterization and perforation in a short time.
View Article and Find Full Text PDFEndosc Int Open
November 2024
Gastroenterology and Hepatology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Although esophagogastroduodenoscopy (EGD) is a widely used technique, the procedure is often associated with discomfort. This study aimed to analyze painful situations, their frequency, and factors associated with patient discomfort during EGD. This prospective observational study included patients scheduled to undergo EGD.
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