Gastric injury secondary to button battery ingestions: a retrospective multicenter review

Published:April 22, 2020DOI:https://doi.org/10.1016/j.gie.2020.04.037

      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)
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      References

        • Ettyreddy A.R.
        • Georg M.W.
        • Chi D.H.
        • et al.
        Button battery injuries in the pediatric aerodigestive tract.
        Ear Nose Throat J. 2015; 94: 486-493
        • Leinwand K.
        • Brumbaugh D.E.
        • Kramer R.E.
        Button battery ingestion in children: a paradigm for management of severe pediatric foreign body ingestions.
        Gastrointest Endosc Clin North Am. 2016; 26: 99-118
        • Brumbaugh D.E.
        • Colson S.B.
        • Sandoval J.A.
        • et al.
        Management of button battery-induced hemorrhage in children.
        J Pediatr Gastroenterol Nutr. 2011; 52: 585-589
        • Litovitz T.
        • Whitaker N.
        • Clark L.
        • et al.
        Emerging battery-ingestion hazard: clinical implications.
        Pediatrics. 2010; 125: 1168-1177
        • Tanaka J.
        • Yamashita M.
        • Yamashita M.
        • et al.
        Esophageal electrochemical burns due to button type lithium batteries in dogs.
        Vet Hum Toxicol. 1998; 40: 193-196
        • Kramer R.E.
        • Lerner D.G.
        • Lin T.
        • et al.
        Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee.
        J Pediatr Gastroenterol Nutr. 2015; 60: 562-574
        • Litovitz T.
        • Whitaker N.
        • Clark L.
        Preventing battery ingestions: an analysis of 8648 cases.
        Pediatrics. 2010; 125: 1178-1183
      1. National Capital Poison Control Center.
        (National capital poison center button battery ingestion triage and treatment guideline. Available at:)
        https://www.poison.org/battery/guideline
        Date accessed: February 9, 2020
        • Orsagh-Yentis D.
        • McAdams R.J.
        • Roberts K.J.
        • et al.
        Foreign-body ingestions of young children treated in US emergency departments: 1995-2015.
        Pediatrics. 2019; : 143
        • Rios G.
        • Rodriguez L.
        • Lucero Y.
        • et al.
        Endoscopic findings associated with button battery ingestion in children: Do we need to change the protocol for managing gastric location?.
        Pediatr Emerg Care. Epub 2018 Jan 23;
        • Al Lawati T.T.
        • Al Marhoobi R.M.
        Timing of button battery removal from the upper gastrointestinal system in children.
        Pediatr Emerg Care. Epub 2018 Dec 27;
        • Lee J.H.
        • Lee J.H.
        • Shim J.O.
        • et al.
        Foreign body ingestion in children: Should button batteries in the stomach be urgently removed?.
        Pediatr Gastroenterol Hepatol Nutr. 2016; 19: 20-28
        • Temple D.M.
        • McNeese M.C.
        Hazards of battery ingestion.
        Pediatrics. 1983; 71: 100-103
        • Honda S.
        • Shinkai M.
        • Usui Y.
        • et al.
        Severe gastric damage caused by button battery ingestion in a 3-month-old infant.
        J Pediatr Surg. 2010; 45: e23-e26
        • Patoulias I.
        • Kaselas C.
        • Patoulias D.
        • et al.
        Multiple gastric erosion early after a 3 V lithium battery (CR2025) ingestion in an 18-month-old male patient: consideration about the proper time of intervention.
        Case Rep Pediatr. 2016;
        • Takagaki K.
        • Perito E.R.
        • Jose F.A.
        • et al.
        Gastric mucosal damage from ingestion of 3 button cell batteries.
        J Pediatr Gastroenterol Nutr. 2011; 53: 222-223
        • Chang Y.J.
        • Chao H.C.
        • Kong M.S.
        • et al.
        Clinical analysis of disc battery ingestion in children.
        Chang Gung Med J. 2004; 27: 673-677
        • Huang T.
        • Li W.Q.
        • Xia Z.F.
        • et al.
        Characteristics and outcome of impacted button batteries among young children less than 7 years of age in China: a retrospective analysis of 116 cases.
        World J Pediatr. 2018; 14: 570-575