Fluoroscopic Foley Catheter Removal of Esophageal Foreign Bodies in Children: Experience With 415 Episodes

Objective. This study sought to investigate the safety and efficacy of the fluoroscopic Foley catheter technique (FFCT) for removal of esophageal foreign bodies (EFBs) in children, and to identify factors associated with decreased success. Design/Setting/Patients. An 11-year retrospective review of all pediatric patients undergoing the FFCT for removal of EFBs at a tertiary-care children's hospital was performed. Results. Four-hundred and fifteen cases are reported. The median age was 29 months (range, 4 to 193); children ≤ 24 months accounted for 45% (185) of the cases. Of all episodes 86% (355) involved children without known esophageal pathology. Coins comprised 76% (316) of the EFBs. The FFCT was successful in 91% (378) of the cases. In the 60 episodes involving children with underlying esophageal pathology, the technique had an 83% success rate compared to 92% in children without known pathology (P < .05). There were 290 patients where the duration of impaction was known. The success rate was 96% if the duration was 3 days or less compared to 50% if the duration was longer (P < .0001). Though the overall success in children ≤ 24 months was less than older children (88% vs 94%, P < .05), this effect disappeared when corrected for duration of impaction. Minor complications occurred in 2% of the episodes, and major complications were noted in 1%. Conclusions. The FFCT appears to be a safe and effective method for removal of EFBs especially in children without underlying esophageal lesions and a duration of impaction ≤ 3 days. Major complications are rare.

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Letters to the Editor

PEDIATRICS ◽

10.1542/peds.96.4.791a ◽

1995 ◽

Vol 96 (4) ◽

pp. 791-791

Author(s):

Gregory P. Conners ◽

James M. Chamberlain ◽

Daniel W. Ochsenschlager

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Foley Catheter ◽

Letters To The Editor ◽

Catheter Technique ◽

Esophageal Foreign Bodies

We enjoyed reading the paper by Schunk et al1 regarding the removal of esophageal foreign bodies using the fluoroscopic Foley catheter technique. We feel, however, that their sentence "Because of the potential for serious complications all impacted foreign bodies should be removed" deserves further clarification. Impacted is defined as "pressed firmly together so as to be immovable."2 Therefore, a foreign body that is impacted in the esophagus is one that will not pass to the stomach without an intervention.

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Foley Catheter and Esophageal Foreign Bodies

PEDIATRICS ◽

10.1542/peds.96.4.791 ◽

1995 ◽

Vol 96 (4) ◽

pp. 791-791

Author(s):

James E. Arnold ◽

Diana Radkowski

Keyword(s):

Success Rate ◽

Cost Reduction ◽

Foreign Bodies ◽

Foley Catheter ◽

Esophageal Disease ◽

Fluoroscopic Guidance ◽

Relative Safety ◽

History Of ◽

Esophageal Foreign Bodies ◽

Clear Presentation

Dr Schunk and colleagues1 have provided a very clear presentation of their use of the Foley catheter with fluoroscopic guidance for removal of esophageal foreign bodies in children. They cite their high success rate and relative safety and infer that this is the procedure of choice based primarily on cost reduction. They properly point out that fluoroscopic-guided catheter extraction should be applied only to blunt foreign bodies that have been lodged for 3 days or less, and there should be no history of esophageal disease.

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Foley catheter removal of blunt esophageal foreign bodies. Experience with 100 consecutive children

Pediatric Radiology ◽

10.1007/bf01624392 ◽

1983 ◽

Vol 13 (3) ◽

pp. 116-118 ◽

Cited By ~ 38

Author(s):

J. B. Campbell ◽

F. L. Quattromani ◽

L. C. Foley

Keyword(s):

Foreign Bodies ◽

Foley Catheter ◽

Catheter Removal ◽

Esophageal Foreign Bodies

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Use of Foley Catheter for Removal of Esophageal Foreign Bodies a Survey

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948209100614 ◽

1982 ◽

Vol 91 (6) ◽

pp. 599-601 ◽

Cited By ~ 22

Author(s):

W. Frederick McGuirt

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Foley Catheter ◽

Esophageal Disease ◽

Negative Results ◽

Trained Personnel ◽

Barium Esophagogram ◽

Esophageal Foreign Bodies

A survey was conducted among otolaryngologists, thoracic surgeons, pediatric surgeons and pediatric radiologists to determine the frequency of removal of esophageal foreign bodies with a Foley catheter. The 245 physicians responding reported 1,512 cases, 96% of which were treated with this technique by radiologists and pediatric surgeons. Although no deaths or serious complications were reported, the author warns that increasing use of this procedure by nonendoscopists carries the risk of serious complications unless certain safeguards are taken. These include trained personnel, use of fluoroscopy, a cooperative patient with a single, smooth, radiopaque foreign body lodged in the esophagus and a barium esophagogram with negative results for total obstruction and underlying esophageal disease.

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Catheter Technique for Extraction of Blunt Esophageal Foreign Bodies

Radiology ◽

10.1148/108.2.438 ◽

1973 ◽

Vol 108 (2) ◽

pp. 438-440 ◽

Cited By ~ 17

Author(s):

John B. Campbell ◽

William S. Davis

Keyword(s):

Foreign Bodies ◽

Catheter Technique ◽

Esophageal Foreign Bodies

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Aerodigestive Tract Foreign Bodies in the Older Child and Adolescent

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949610500404 ◽

1996 ◽

Vol 105 (4) ◽

pp. 267-271 ◽

Cited By ~ 65

Author(s):

Paul S. Lemberg ◽

David H. Darrow ◽

Lauren D. Holinger

Keyword(s):

Foreign Body ◽

Children And Adolescents ◽

Foreign Bodies ◽

Distinct Group ◽

Aerodigestive Tract ◽

Older Children ◽

Patients At Risk ◽

History Of ◽

Group 5 ◽

Esophageal Foreign Bodies

This study was undertaken in order to establish the incidence of aerodigestive tract foreign body accidents among older children and adolescents, and to investigate the circumstances surrounding these events. A review of patients treated over a 5-year period identified 367 children from whom aerodigestive tract foreign bodies were removed. Seventeen percent of these patients were 5 years of age or older. Among these children, 88% aspirated nonfood items, half of which were school supplies; 78% of the group 5 years old and under aspirated food items. Among older children with esophageal foreign bodies, 31 % had food impactions, compared with 7% in the younger group; 70% of these children had a history of some anatomic abnormality of the esophagus. These data suggest that older children and adolescents represent a distinct group of patients at risk for foreign body accidents. Pediatricians and parents of children in this age group should discourage the practice of using the oral cavity as a repository for school supplies, and should stress the need for adequate preparation and mastication of food, particularly among children with esophageal abnormalities.

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Pediatric External Auditory Canal Foreign Bodies: A Review of 698 Cases

Otolaryngology ◽

10.1067/mhn.2002.126724 ◽

2002 ◽

Vol 127 (1) ◽

pp. 73-78 ◽

Cited By ~ 59

Author(s):

Stacey L. Schulze ◽

Joseph Kerschner ◽

David Beste

Keyword(s):

Patient Outcomes ◽

External Auditory Canal ◽

Foreign Bodies ◽

Pediatric Patients ◽

Tertiary Care ◽

Patient Characteristics ◽

Complication Rates ◽

Direct Visualization ◽

Success Rates ◽

Poor Outcomes

OBJECTIVE: The study goal was to determine the relationships between patient management factors and patient outcomes in pediatric patients with external auditory canal foreign bodies. STUDY DESIGN AND SETTING: Retrospective analysis was conducted of 698 consecutive cases of pediatric external auditory canal foreign bodies (n = 605 patients) who presented to a tertiary care pediatric referral center during a 6-year period. RESULTS: Emergency physicians frequently removed foreign bodies under direct visualization while otolaryngologists primarily used otomicroscopy. Both of these methods had high success rates overall (77% and 86%), but attempts under direct visualization had lower success rates with removing spherical objects, objects touching the tympanic membrane, and objects in the canal for more than 24 hours. Failed removal attempts resulted in higher complication rates. CONCLUSION: Certain foreign body and patient characteristics are associated with poor outcomes with removal attempts made under direct visualization. These cases should be referred directly to otolaryngologists for otomicroscopic removal.

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Esophageal Foreign Bodies in Pediatric Patients: A Thirteen-Year Retrospective Study

The Scientific World JOURNAL ◽

10.1100/2012/102642 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 17

Author(s):

Beata Rybojad ◽

Grazyna Niedzielska ◽

Artur Niedzielski ◽

Ewa Rudnicka-Drozak ◽

Pawel Rybojad

Keyword(s):

Retrospective Study ◽

Foreign Bodies ◽

Pediatric Patients ◽

Clinical Symptoms ◽

X Rays ◽

Chi Square ◽

X Ray ◽

Rigid Esophagoscopy ◽

Plain Chest ◽

Esophageal Foreign Bodies

We discuss clinical symptoms and radiological findings of variable esophageal foreign bodies as well as therapeutic procedures in Caucasian pediatric patients. A retrospective study of 192 cases of suspected esophageal foreign bodies between 1998 and 2010 was conducted. Data were statistically analyzed by chi-square test. A foreign body was removed from a digestive tract of 163 children aged 6 months to 15 years (mean age 4.9). Most objects were located within cricopharyngeal sphincter. Dysphagia occurred in 43%, followed by vomiting (29%) and drooling (28%). The most common objects were coins. Plain chest X-rays demonstrated aberrations in 132 cases, and in doubtful situations an esophagram test was ordered. In the group of thirty-seven patients whose radiograms were normal, esophagoscopy revealed fifteen more objects, which were eventually successfully removed. No major complications occurred. Esophagram should be a second X-ray examination if an object is not detected in plain chest X-ray. We recommend a rigid esophagoscopy under general anesthesia in doubtful cases as a safe treatment for pediatric patients.

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