Background and Aims
Removal of gastric button batteries (BBs) remains controversial. Our aim was to better
define the spectrum of injury and to characterize clinical factors associated with
injury from retained gastric BBs.
Methods
In this multicenter retrospective cohort study from January 2014 through May 2018,
pediatric gastroenterologists from 4 pediatric tertiary care centers identified patients,
aged 0 to 18 years, who had a retained gastric BB on radiography and subsequently
underwent endoscopic assessment. Demographic and clinical information were abstracted
from electronic health records using a standard data collection form.
Results
Sixty-eight patients with a median age of 2.5 years underwent endoscopic retrieval
of a gastric BB. At presentation, 17 (25%) were symptomatic. Duration from ingestion
to endoscopic removal was known for 65 patients (median, 9 hours [interquartile range,
5-19]). Median time from ingestion to first radiographic evaluation was 2 hours. At
endoscopic removal, 60% of cases had visual evidence of mucosal damage, which correlated
with duration of BB retention (P = .0018). Time to retrieval of the BB was not statistically significant between symptomatic
and asymptomatic subjects (P = .12). After adjusting for age and symptoms, the likelihood of visualizing gastric
damage among patients who had BBs removed 12 hours post ingestion was 4.5 times that
compared with those with BB removal within 12 hours of ingestion.
Conclusions
In this study, swallowed BBs posed a risk of damage to the stomach, including a single
case of impaction and perforation of the gastric wall. Clinicians may want to consider
retrieval within 12 hours of ingestion of gastric BBs. Larger prospective studies
to assess risk of injury are needed.
Abbreviations:
BB (button battery), BBI (button battery ingestion), IQR (interquartile range)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 22, 2020
Accepted:
April 8,
2020
Received:
December 14,
2019
Footnotes
DISCLOSURE: The following authors received research support for this study from the Cystic Fibrosis Foundational Grant Award (no. Khalaf17B0, HAZLET15B0, and HAZLET18D0) and National Institutes of Health Training Grant 5T32-DK067009-12: R. Khalaf, K. Hazleton; National Institutes of Health Training Grant 5T32-DK7664-28: W. Ruan; National Institutes of Health Training Grant NIH 5T32-DK0077-27: S. Orkin; and Sondheimer Fellow Funds (R. Khalaf) from Children’s Hospital Colorado. In addition, the following author disclosed financial relationships: D. S. Fishman: Paid contributor to UpToDate. All other authors disclosed no financial relationships.
See CME section; p. 404.
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© 2020 by the American Society for Gastrointestinal Endoscopy
