Subscribe to RSS
30 Years of Flipping the Coin—Heads or Tails?
Introduction Swallowed coins are a frequent cause of pediatric emergency department visits. Removal typically involves endoscopic retrieval under anesthesia. We describe our 30-year experience retrieving coins using a Foley catheter under fluoroscopy (“coin flip”).
Materials and Methods Patients younger than 18 years who underwent the coin flip procedure from 1988 to 2018 were identified. Failure of fluoroscopic retrieval was followed by rigid endoscopic retrieval in the operating room. Detailed subanalysis of patients between 2011 and 2018 was also performed.
Results A total of 809 patients underwent the coin flip procedure between 1988 and 2018. Median age was 3.3 years; 51% were male. The mean duration from ingestion to presentation was 19.8 hours. Overall success of removal from the esophagus was 85.5%, with 76.5% of coins retrieved and 9% pushed into the stomach. All remaining coins were retrieved by endoscopy. Complication rate was 1.2% with nine minor and one major complications, a tracheal tear that required repair. In our recent cohort, successful fluoroscopic removal led to shorter hospital lengths of stay (3.2 vs. 18.1 hours, p < 0.001).
Conclusion Patients who present with a coin in the esophagus can be successfully managed with a coin flip, which can be performed without hospital admission, with rare complications.
Received: 24 March 2020
Accepted: 10 September 2020
Article published online:
03 November 2020
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Abdurehim Y, Yasin Y, Yaming Q, Hua Z. Value and efficacy of Foley catheter removal of blunt pediatric esophageal foreign bodies. ISRN Otolaryngol 2014; 2014: 679378
- 2 Jayachandra S, Eslick GD. A systematic review of paediatric foreign body ingestion: presentation, complications, and management. Int J Pediatr Otorhinolaryngol 2013; 77 (03) 311-317
- 3 Waltzman ML. Management of esophageal coins. Curr Opin Pediatr 2006; 18 (05) 571-574
- 4 Chen X, Milkovich S, Stool D, van As AB, Reilly J, Rider G. Pediatric coin ingestion and aspiration. Int J Pediatr Otorhinolaryngol 2006; 70 (02) 325-329
- 5 Gasior AC, Knott EM, Sharp SW, Snyder CL, St Peter SD. Predictive factors for successful balloon catheter extraction of esophageal foreign bodies. Pediatr Surg Int 2013; 29 (08) 791-794
- 6 Little DC, Shah SR, St Peter SD. et al. Esophageal foreign bodies in the pediatric population: our first 500 cases. J Pediatr Surg 2006; 41 (05) 914-918
- 7 Morrow SE, Bickler SW, Kennedy AP, Snyder CL, Sharp RJ, Ashcraft KW. Balloon extraction of esophageal foreign bodies in children. J Pediatr Surg 1998; 33 (02) 266-270
- 8 Rubin SZ, Mueller DL. Removal of esophageal foreign bodies with a Foley balloon catheter under fluoroscopic control. CMAJ 1987; 137 (02) 125-127
- 9 Schunk JE, Harrison AM, Corneli HM, Nixon GW. Fluoroscopic foley catheter removal of esophageal foreign bodies in children: experience with 415 episodes. Pediatrics 1994; 94 (05) 709-714
- 10 Bigler FC. The use of a Foley catheter for removal of blunt foreign bodies from the esophagus. J Thorac Cardiovasc Surg 1966; 51 (05) 759-760
- 11 Agarwala S, Bhatnagar V, Mitra DK. Coins can be safely removed from the esophagus by Foley's catheter without fluoroscopic control. Indian Pediatr 1996; 33 (02) 109-111
- 12 Campbell JB, Quattromani FL, Foley LC. Foley catheter removal of blunt esophageal foreign bodies. Experience with 100 consecutive children. Pediatr Radiol 1983; 13 (03) 116-118
- 13 Shackelford GD, McAlister WH, Robertson CL. The use of a Foley catheter for removal of blunt esophageal foreign bodies from children. Radiology 1972; 105 (02) 455-456
- 14 Symbas PN. Indirect method of extraction of foreign body from the esophagus. Ann Surg 1968; 167 (01) 78-80
- 15 Berggreen PJ, Harrison E, Sanowski RA, Ingebo K, Noland B, Zierer S. Techniques and complications of esophageal foreign body extraction in children and adults. Gastrointest Endosc 1993; 39 (05) 626-630
- 16 Ham III PB, Ellis MA, Simmerman EL. et al. Analysis of 334 cases of pediatric esophageal foreign body removal suggests that traditional methods have similar outcomes whereas a magnetic tip orogastric tube appears to be an effective, efficient, and safe technique for disc battery removal. Am Surg 2018; 84 (07) 1152-1158
- 17 McGuirt WF. Use of Foley catheter for removal of esophageal foreign bodies. A survey. Ann Otol Rhinol Laryngol 1982; 91 (6 Pt 1): 599-601
- 18 Gonzalez KW, Reddy SR, Mundakkal AA, St Peter SD. The financial impact of flipping the coin. J Pediatr Surg 2017; 52 (01) 153-155
- 19 Campbell JB, Condon VR. Survey of the Society for Pediatric Radiology. Catheter removal of blunt esophageal foreign bodies in children. Pediatr Radiol 1989; 19 (6-7): 361-365
- 20 Calkins CM, Christians KK, Sell LL. Cost analysis in the management of esophageal coins: endoscopy versus bougienage. J Pediatr Surg 1999; 34 (03) 412-414
- 21 Conners GP. A literature-based comparison of three methods of pediatric esophageal coin removal. Pediatr Emerg Care 1997; 13 (02) 154-157
- 22 Kelley JE, Leech MH, Carr MG. A safe and cost-effective protocol for the management of esophageal coins in children. J Pediatr Surg 1993; 28 (07) 898-900
- 23 Soprano JV, Mandl KD. Four strategies for the management of esophageal coins in children. Pediatrics 2000; 105 (01) e5
- 24 Shah SR, Little DC. Ingestion of foreign bodies. In: Holcomb III GW, Murphy JP, St Peter SD. eds. Holcomb and Ashcraft's Pediatric Surgery. 7th ed.. St. Louis (MO): Elsevier; 2019: 172-180
- 25 Wennervaldt K, Melchiors J. Risk of perforation using rigid oesophagoscopy in the distal part of oesophagus. Dan Med J 2012; 59 (11) A4528
- 26 Vilas-Boas F, Pereira P, Baldaque-Silva F. et al. Esophageal intramural dissection after rigid esophagoscopy. Gastrointest Endosc 2014; 79 (06) 996-997
- 27 O'Neill Jr JA, Holcomb Jr GW, Neblett WW. Management of tracheobronchial and esophageal foreign bodies in childhood. J Pediatr Surg 1983; 18 (04) 475-479
- 28 Bonadio WA, Jona JZ, Glicklich M, Cohen R. Esophageal bougienage technique for coin ingestion in children. J Pediatr Surg 1988; 23 (10) 917-918
- 29 Dahshan AH, Kevin Donovan G. Bougienage versus endoscopy for esophageal coin removal in children. J Clin Gastroenterol 2007; 41 (05) 454-456
- 30 Emslander HC, Bonadio W, Klatzo M. Efficacy of esophageal bougienage by emergency physicians in pediatric coin ingestion. Ann Emerg Med 1996; 27 (06) 726-729
- 31 Arms JL, Mackenberg-Mohn MD, Bowen MV. et al. Safety and efficacy of a protocol using bougienage or endoscopy for the management of coins acutely lodged in the esophagus: a large case series. Ann Emerg Med 2008; 51 (04) 367-372