Fluoroscopy has long been an essential imaging modality in pediatric radiology. However, concerns about radiation exposure in children and the need for on-site staff have led to a decline in its use and the exploration of alternative imaging techniques. Data from the Pediatric Health Information System and our institution show a decrease in fluoroscopic studies among pediatric inpatients, from 56,371 per year (2017-2020) to 46,973 per year (2020-2023). Alternative modalities such as endoscopy, ultrasound, and computed tomography demonstrate promise in assessing conditions of the respiratory, gastrointestinal, and urinary systems. Although fluoroscopy remains valuable in certain scenarios, these alternative imaging modalities offer advantages in terms of diagnostic accuracy, accessibility, costs, and reduced radiation exposure. However, the final choice of imaging technique should be based on careful consideration of the specific clinical context, patient factors, and available resources. In this review, we present institutional and national trends on the utilization of fluoroscopic studies over the past years, along with a side-by-side comparison of traditional fluoroscopic studies commonly performed in children and newer alternative modalities.

Multiple magnetic foreign body ingestion can cause serious complications in children. Such events are now more frequently seen. We report such a case and present a systematic review to identify the variety of fistulae thereby caused. Timely diagnosis through radiographic imaging plays a pivotal role in guiding clinical decisions.

Accidental foreign body (FB) ingestion is common in the pediatric age group between six months and five years. Most ingested FBs pass easily through the esophagus, into the stomach, and are expelled from the body without complications. However, some of these foreign bodies may get stuck in any part of the gastrointestinal (GI) tract, and endoscopic removal may be required to avoid complications. We present a case involving the endoscopic removal of an open safety pin from the duodenum of a two-year-old boy. The safety pin went unnoticed until the mother realized one was missing, leading to an incidental diagnosis.

Decorative crystal balls, also known as superabsorbent polymer gel beads, pose a significant hazard when ingested due to their ability to expand upon exposure to water. Diagnosing crystal ball ingestion remains challenging because of their transparency to radiation, making them difficult to visualize using X-ray imaging. Small crystal balls may not be detected in their early stages, only becoming visible once they fully swell and cause intestinal obstruction. This often results in some crystal balls remaining in the distal intestine after primary surgery aimed at removing the proximal crystals.

A 2-year-old girl was referred to our hospital with persistent vomiting and fever. She was diagnosed with acute intestinal obstruction, and imaging revealed features of dynamic obstruction. Emergency laparotomy identified an obstruction in the mid-terminal ileum caused by a superabsorbent polymer gel bead (crystal ball). A jelly-like mass measuring 4x4.5 cm was removed and sent for histopathological examination. Intestinal anastomosis was performed during the initial surgery to restore bowel continuity. Postoperatively, complications arose, including infection in the abdominal cavity and breakdown of the anastomosed area. A previously missed gel bead, referred to as "crystal baby," which had not been identified during the initial surgery, caused severe leakage and infection. Given the high risk of further anastomotic complications, a double-lumen ileostomy was performed. The child's condition improved, and follow-up imaging one month after surgery revealed no further obstruction.

This case highlights the diagnostic and surgical challenges associated with crystal balls (superabsorbent polymer gel beads) and emphasizes the need for careful management to prevent severe complications. It also underscores the risks of intestinal anastomosis in such cases and the necessity of alternative approaches, such as ileostomy, to ensure better outcomes.

This study aims to investigate the risk of pediatric bowel obstruction from various types of super absorbent polymer (SAP) beads in different liquid media, explore treatment options, and develop a clinical decision-making algorithm for healthcare providers.

Three experiments were conducted involving the measurement of SAP beads' expansion in different liquid media. The first experiment examined the expansion of beads in tap water, gastric fluid, and small intestine fluid. The second compared the expansion of beads from six manufacturers in water. The third tested the effect of varying concentrations of Polyethylene Glycol 3350 on bead expansion.

The study found that SAP beads reached their largest size in water, with significant size-dependent and solution-specific effects on their expansion. Large beads had a β of 12.67 (95% CI: 10.25-15.1; p < 0.001) compared to small beads. Gastric acid reduced expansion with a β of -7.01 (95% CI: -9.67 to 4.35; p < 0.001) and alkaline solution with a β of -3.88 (95% CI: -6.54 to 1.23; p = 0.002) compared to water. Treatment solutions containing high concentrations of polyethylene glycol (PEG) 3350 effectively reduced the size of the beads (p < 0.001).

This research highlights the importance of understanding the characteristics and risks associated with SAP beads to mitigate the dangers they pose to pediatric populations. Our findings underscore the need for standardized management of SAP bead ingestion, which could improve patient outcomes while reducing unnecessary diagnostic and therapeutic interventions. Further research and clinical validation of these strategies in vivo are essential to develop safe and efficient protocols for managing SAP bead ingestions.

This study aimed to develop and validate a reliable nomogram based on clinical factors to predict complications associated with pediatric multiple magnet ingestion, addressing the urgency and controversy surrounding its management.

Patients aged 0-18 years with multiple magnet ingestion diagnosed at the Shenzhen Children's Hospital between January 2017 and December 2023 were enrolled. Clinical data were analyzed using least absolute shrinkage and selection operator regression and multifactor logistic regression analyses to screen for risk factors. A model was constructed, and a nomogram was plotted. Model performance was evaluated and internally validated using the area under the curve (AUC), Hosmer-Lemeshow test, calibration curve, decision curve analysis, and 1,000 bootstraps. We calculated the optimal cutoff value, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the prediction model.

Of the 146 patients, 57 (39.0%) experienced complications. The nomogram included age, multiple ingestions, vomiting, abdominal pain, and abdominal tenderness. The AUC was 0.941, and the internally validated AUC was 0.930. The optimal cutoff value selected as a predictive value was 0.534, with a sensitivity of 82.5%, specificity of 93.3%, positive predictive value of 88.7%, negative predictive value of 89.3%, and accuracy of 89.0%. The Hosmer-Lemeshow test yielded a P value of 0.750. The calibration plot exhibited high consistency in prediction, and decision curve analysis showed excellent net benefits.

Our nomogram demonstrates excellent discrimination, calibration, and clinical utility and may thus help clinicians accurately assess the risk of complications from pediatric multiple magnet ingestion.

To identify factors associated with the spontaneous passage of ingested foreign bodies.

A prospective observational cohort study was conducted at a tertiary pediatric surgery center from July 2022 to March 2024. Management followed a standardized protocol, with follow-up period of over 6 months.

The study included 139 children with a mean age of 6.9 years, and 53% of them were boys. Blunt objects, mainly coins, were the most frequently ingested (60%). Most children (88%) were asymptomatic, but 9% reported abdominal pain, particularly with sharp object ingestion (P = 0.006). Spontaneous passage occurred in most cases, with a mean transit time of 119 ± 105 h. Sharp objects passed faster than blunt ones (87 ± 60 h vs. 141 ± 122 h; P = 0.01). Delayed passage was associated with larger object diameter, constipation, and significant colon loading on X-ray. The optimal cutoff diameter predicting a transit time over 72 h for blunt objects was 1.75 cm. Nine children required intervention, and no long-term complications were observed.

Most ingested foreign bodies pass spontaneously without complications. Sharp objects transit faster than blunt objects, and transit time is influenced by object size, constipation, and colon loading.

Foreign body ingestion (FBI) is a common clinical presentation, with most cases occurring in children. While accidental FBI in adults is less frequent, it is often associated with psychiatric conditions or substance use disorders. Magnet ingestion is particularly concerning due to the risk of pressure necrosis, perforation, and fistula formation, yet reports of magnet retention in adults are exceedingly rare. We describe a 45-year-old male with a history of depression and substance use disorder who presented with a three-week history of progressive abdominal pain, nausea, bloating, and foul-smelling belching. Imaging revealed a radiopaque foreign body in the distal gastric antrum, later identified as a 2.5 cm metallic disc-shaped magnet. Notably, a prior CT scan performed two years earlier had documented the same object, which the patient had presumed to be a dental filling and expected to pass spontaneously. Esophagogastroduodenoscopy (EGD) successfully retrieved the magnet using a Roth net, with immediate symptom resolution. This case is unique due to the prolonged asymptomatic retention of a magnet for two years before the onset of gastric outlet obstruction symptoms. While most foreign bodies pass spontaneously, endoscopic retrieval is warranted for magnets to prevent potential complications. The prolonged retention without perforation or obstruction highlights the role of anatomic location and object characteristics in determining outcomes. To our knowledge, this is the first reported case of successful endoscopic removal of a long-retained magnet in an adult using a Roth net. This case underscores the importance of considering FBI in the differential diagnosis of unexplained gastrointestinal symptoms, particularly in high-risk patients. Early recognition and intervention are crucial to prevent severe complications. Endoscopic removal remains a safe and effective strategy even for delayed presentations, emphasizing the need for clinical vigilance in cases of unwitnessed FBI.

Accidental ingestion of batteries is well documented in pediatric medical literature, but very few data exist in pediatric medical literature about ingestions of cylindrical batteries (CBs). The aim of our study was to evaluate the features, clinical presentation and clinical outcome of children who have ingested CBs.

All children admitted for CB ingestion were retrospectively recruited. Clinical data until hospital discharge were accurately recorded, including child age and sex, ingestion modality, signs and symptoms following ingestion, type of CB, results of neck-chest-abdominal x-ray performed to assess the retention site of CB, outcome of endoscopic removal, and whether performed.

Forty-five children (males/females: 26/19; age range: 7-168 months; mean age ± standard deviation: 42 ± 33.9 months) were enrolled. Of them, 15 of 45 (33.3%) had ingested AA batteries whereas 30 of 45 (66.6%) had ingested AAA batteries. CBs were retained in the esophagus in two of 45 children (4.4%), in the stomach in 19 of 45 children (42.2%), and in the duodenum or beyond in the remaining 24 of 45 children (53.3%). None of the patients who underwent endoscopic removal (12/45) had any esophageal or gastric mucosal lesions. No cases of intestinal perforation or surgical complications were reported.

According to our study data, conservative management may be advised for the majority of cases of CB ingestion. However, we acknowledge that CB should be timely removed whenever they are A23 or A27 type, damaged prior to ingestion, in cases of multiple ingestion, whenever retained in the stomach for a prolonged period, or whenever a child complains about any clinical signs or symptoms or had undergone prior abdominal surgery.

Foreign body ingestion (FBI) in children is a critical health concern. This study aimed to describe the epidemiology of FBI in children in Italy.

We retrospectively enrolled children <18 years admitted for FBI from January 2015 to December 2020. Data were collected across 21 hospitals with dedicated pediatric endoscopy services and normalized by the population of the corresponding municipalities.

A total of 5,771 FBI cases were analyzed. FBI incidents showed consistent time trends across age groups, with most events occurring at home and being witnessed (94.7 %). Children <6 years accounted for 74.3 % of cases. Comorbidities were present in 5.3 % of cases, primarily neurologic/psychiatric disorders in older children (6-17 years). Blunt objects accounted for 65.5 % of ingestions. Young males commonly ingested button batteries, while females showed higher rates of ingesting hair products and jewelry. Most children were discharged (60 %) or observed briefly (75 % of total admissions), with endoscopic removal performed in 24 % of cases.

Rates of FBI have remained stable over the years, including during the COVID-19 pandemic. FBI predominantly occurs in domestic settings among healthy young children, particularly those ≤5 years old. These findings emphasize the need for preventive measures to reduce the impact of FBI among children.

To propose a gastrointestinal bleeding management algorithm that incorporates an endoscopic and imaging scoring system and specifies management of vascular complication from button battery ingestion.

Button batteries (BB) are found in many electronic devices and ingestions are associated with serious complications especially in cases of unwitnessed ingestions, prolonged impaction, and in children less than 5 years of age. Gastrointestinal bleeding from BB related vascular injury is rare but often rapidly fatal, with a mortality rate as high as 81%. There are no evidence-based guidelines for managing vascular complications from button battery ingestions. This paper proposes a management algorithm that 1) incorporates both an endoscopic and imaging scoring system to guide initial, post procedure, and discharge care and 2) specifies management of button battery related vascular bleeding. The endoscopic score is a modified Zargar classification with added categories for suspected aneurysm and tracheoesophageal fistula. Surgical and endovascular interventions for vascular injury are also reviewed. Until evidence-based guidelines can be developed, hospitals should have a multidisciplinary protocol based on institutional expertise to rapidly manage BB related vascular injury. Prevention of BB related injury offers the best hope of preventing serious complications and should include increasing public awareness and improving safety standards by working with industry and government.

Impacted esophageal foreign bodies (EFBs) are a common but preventable presentation in children, requiring prompt removal in the operating room by esophagoscopy. Our objective was to describe the overall cost of impacted pediatric EFBs and determine factors that increase resource burden.

A cost analysis of pediatric patients undergoing esophagoscopy for EFB removal from 2010 to 2021 was performed. Characteristics of each EFB, patient transfer, and hospital course were collected. Direct and indirect healthcare costs were calculated using hospital-specific costs and provincial fees. Amounts were calculated in Canadian dollars.

Six hundred and eighty patients were included. The total amount spent on pediatric EFBs from 2010 to 2021 was $2,673,288. The mean total cost per child with an EFB was $3469. An extra hour of delay before Otolaryngology-Head and Neck Surgery (OHNS) consultation at a tertiary hospital corresponded to an $816 cost [95% confidence interval (CI; 244.7-1287.4)]. On average, children requiring transfer to a tertiary care center cost $1965 more than those initially presenting to a tertiary care center (P = .001). Higher-risk EFBs (n = 165, 24%) were associated with a longer hospital stay and greater complication rate and resulted in a $4095 increase in overall cost compared to lower-risk EFBs [$6829 (standard deviation (SD) $11,347) vs $2734 (SD $10,451), P = .02]. Button battery ingestions cost 8.8 times more than non-dangerous EFBs, such as coins. Longer distance for transfer was associated with a higher likelihood of having complications [odds ratios (OR) 1.5, 95% CI (1.1-1.8)].

EFBs pose a significant economic burden to the healthcare system, driven by transfer to a tertiary care center, delays in transfer to the operating room, and high-risk EFBs. It is critical to identify areas for improved efficiency such as increased parental education for primary prevention, early involvement of the OHNS team and improving the capacity of community hospitals to manage EFB to limit transfers when possible.

Background: The incidence of multiple magnetic foreign body (MMFB) ingestion in children is rising, which poses a serious risk for gastrointestinal tract injury. In the current study, the clinical characteristics were analyzed to enhance awareness among parents and caregivers, treatment experiences were summarized and discussed, and optimal treatment plans were identified. Methods: A retrospective analysis was performed on 130 pediatric patients with MMFB ingestion at the Children's Hospital Affiliated with Zhejiang University School of Medicine, between June 2016 and June 2023. The clinical data, treatment details, and patient prognosis were systematically collected. Results: Forty-one patients were managed conservatively, while 89 patients underwent open surgery. Among the 44 patients who were treated with laparoscopic surgery, conversion to laparotomy was necessary in 28. The risk of gastrointestinal perforation was higher in symptomatic children than in asymptomatic children (chi-square value: 37.156; P < .001). Perforations were mainly observed in the small intestine. The median length of hospital stay was 10 days in the cohort of 16 children who underwent laparoscopic surgery successfully, which differed from the group of 28 children who were converted to a laparotomy (10 days [interquartile range, or IQR: 9-12.75 days] versus 12 days [IQR: 10-15.75 days]; P < .05). Conclusions: The ingestion of MMFBs in children can lead to severe injuries, underscoring the importance of early detection and treatment. Tailored clinical management strategies should be implemented based on individual conditions, while prompt and effective interventions can minimize harm. Therefore, we propose a comprehensive framework for individualized treatment processes.

Coins are the most commonly ingested foreign bodies. When they get stuck in the distal esophagus, there is no general agreement about the timing of their removal because some of them may spontaneously migrate into the stomach, no longer requiring removal. We aimed at evaluating the gastric spontaneous passage of esophageal-retained coins, as well as complications.

Children admitted for coin ingestion were enrolled.

Eight hundred seven children were enrolled. Among the medium-distal esophageal retained coins, we reported a spontaneous gastric dislocation in 65%, with no further need for endoscopy.

When coins are trapped in the middle/lower esophagus, we suggest withholding the procedure for at least 6-12 hours, especially for older children, because 2/3 pass spontaneously, not requiring endoscopic removal.

Button battery ingestions pose a serious threat to paediatric health and are on the rise worldwide. Little is known about Canadian data. This study described the type of button battery ingestions Canadian paediatric physicians have observed, including treatment and complications.

A Canadian Paediatric Surveillance Program (CPSP) survey was sent to paediatricians and paediatric subspecialists. The questions were developed through a literature review and consultation with 19 CPSP members, before piloting with 5 paediatric physicians. Descriptive analyses were conducted.

The response rate was 39% (n = 1067/2716). Few were aware of treatment options with honey (n = 189/1067, 18%) and sucralfate (n = 118/1067, 11%). Two hundred and ninety-nine physicians (28%) had been involved in a case in the past 1 year (n = 132 case details). Children < 3 years were most affected (n = 67/132, 51%). In unwitnessed ingestions (n = 41/132, 31%), the most common symptoms were dysphagia (n = 14/41, 34%) and coughing (n = 10/41, 24%). When it was known where the child found the battery, it was most commonly loose in the environment (n = 34/132, 26%). Seventy per cent of patients (n = 92/132) presented within 6 h following the ingestion. Six per cent (n = 8/132) reported the battery eroding into important adjacent structures (eg, aorta and trachea).

A high degree of suspicion for button battery ingestion is needed in young children presenting with dysphagia and coughing. Prevention efforts should be aimed at battery disposal and security. There is a need for dissemination of guidelines to physicians caring for paediatric patients, since modifiable patient factors, such as honey and/or sucralfate administration while awaiting definitive treatment, can improve outcomes.

Evaluate implementation of an institutional protocol to reduce the time to removal of esophageal button battery (BB) and increase use of mitigation strategies.

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.

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%.

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.

3, Case-series Laryngoscope, 134:5170-5177, 2024.

Children frequently swallow or inhale foreign objects, a situation that can be life-threatening. Radiographic imaging plays a lead role in the early identification and location of inhaled or swallowed objects is essential. Promptly identifying and locating inhaled or swallowed objects are essential, as some items require immediate removal. For example, button batteries in the throat can cause grave harm; magnets can attract each other through the gut and cause perforations; and other objects can obstruct the airway or intestinal tract. Radiologists must understand how these objects appear in images to assist doctors in treating patients effectively. Recognising signs of inhaled objects on radiographs is also crucial, as symptoms may not always be clear, and many inhaled objects are not visible on radiographs. Radiographs are the primary means of checking for swallowed or inhaled objects, although other tests like fluoroscopy and computed tomography may be used in complex cases. Doctors working with children should be acquainted with the appearance of these common objects on images and their clinical importance.

Diagnostic and therapeutic endoscopic procedures in children are fundamental to the subspecialty of pediatric gastroenterology. This review highlights significant advancements and trends in pediatric endoscopy, emphasizing the transformative impact of technological innovations in the field. The advent of ultra-thin endoscopes and the development of minimally-invasive techniques have markedly enhanced both diagnostic and therapeutic capabilities, leading to safer and more effective procedures for pediatric patients. Key advancements include transnasal endoscopy, endoscopic ultrasound, and per-oral endoscopic myotomy.

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. Therefore, more active treatment strategies should be taken once button battery ingestion occurs. Surgical treatment is traumatic and prone to cause various complications, so removal of foreign body retained in the esophagus under endoscopy is the preferred strategy.

We introduced a new method to remove the button battery retained in the esophagus of a 17-month-old child. Soon after the patient arrived at the hospital, we actively arranged endoscopic surgery. After the gastroscope entered the esophageal inlet, we first cleaned up the esophageal residues, and then, the button battery was exposed. The surrounding esophageal mucosa showed a little cauterization-like damage. We tried to remove the foreign body using foreign body forceps first, but failed after repeated attempts. Then, we tried to use a disposable balloon to assist in dragging the foreign body, but because the patient was younger with narrower esophagus and the drag resistance of the foreign body was abnormally large, this method also did not work. Violent dragging may cause tearing and perforation of the esophagus. Hence, we used a columnar balloon to help expand the esophagus and successfully removed the button battery at the entrance of the esophagus. For this new method, the columnar balloon was used to expand the esophagus and the button battery was clamped with foreign body forceps, and then, the foreign body was dragged by a disposable stone removal balloon. Because two types of balloons were used, it was named double-balloon method.

For the foreign body retained in the esophagus of younger children, the double -balloon method is recommended when the foreign body cannot be removed by traditional methods.

Kinetic magnetic sand, composed of ultra-fine sand and dimethicone in a 98%-2% ratio, is a versatile sensory toy known for its moldable properties and structural stability (1). Despite the name, it lacks actual magnetic features. Ingesting kinetic sand can pose risks, including choking and gastrointestinal issues, especially in young children. This case report details a unique incident involving a 3-year-old who ingested a significant amount of kinetic sand. Although the sand's ingredients are generally hypoallergenic and nontoxic, its grainy texture presented challenges for retrieval. The patient was closely monitored, and ultimately, the sand passed without complications. While no official guidelines exist for managing such cases, individual assessments, considering factors such as ingestion time, symptoms, and age, are crucial for determining the appropriate course of action, which may range from observation to more invasive procedures like endoscopy or surgery.

While management protocols of pediatric esophageal foreign bodies (EFBs) are well-delineated, resource utilization can be improved. This study's objectives were to explore hospital charges/costs for pediatric patients who present with EFBs and to identify patient risk factors associated with esophageal injury.

A retrospective chart review of patients undergoing aerodigestive foreign body removal at a tertiary-care children's hospital from 2018 to 2021 was conducted. Data collected included demographics, medical history, presenting symptoms, EFB type, surgical findings, and hospital visit charges/costs.

203 patients were included. 178 of 203 (87.7%) patients were admitted prior to operation. Unwitnessed EFB ingestion (p < 0.001, OR = 15.1, 95% CI = 5.88-38.6), experiencing symptoms for longer than a week (p < 0.001, OR = 11.4, 95% CI = 3.66-38.6) and the following presenting symptoms increased the odds of esophageal injury: dysphagia (p = 0.04, OR = 2.45, 95% CI = 1.02-5.85), respiratory distress (p = 0.005, OR = 15.5, 95% CI = 2.09-181), coughing (p < 0.001, OR = 10.1, 95% CI = 3.73-28.2), decreased oral intake (p = 0.001, OR = 6.60, 95% CI = 2.49-17.7), fever (p = 0.001, OR = 5.52, 95% CI = 1.46-19.6), and congestion (p = 0.001, OR = 8.15, 95% CI = 2.42-27.3). None of the 51 asymptomatic patients had esophageal injury. The median total charges during the encounter was $20,808 (interquartile range: $18,636-$24,252), with operating room (OR) (median: $5,396; 28.2%) and inpatient admission (median: $5,520; 26.0%) contributing the greatest percentage.

Asymptomatic patients with EFBs did not experience esophageal injury. The OR and inpatient observation accounted for the greatest percentage of the hospital charges. These results support developing a potential algorithm to triage asymptomatic patients to be managed on a same-day outpatient basis to improve the value of care.

3 Laryngoscope, 134:4774-4782, 2024.

Disk battery (DB) ingestion in children can lead to severe complications and mortality. This study details our experience in managing DB ingestion and its complications.

We analyzed data from all patients treated for DB ingestion at our hospital from June 2010 to January 2024. A protocol established in 2010 requires angio-CT scans for esophageal DB cases and a multidisciplinary approach involving gastroenterologists, otolaryngologists, pediatric and airway surgeons, and cardiac surgeons.

We treated 22 patients. In June 2010, following the tragic death of a patient from an undiagnosed DB ingestion that led to an aortoesophageal fistula, our protocol was established. All DBs were removed endoscopically. Four patients needed additional surgery: two had tracheal resection/anastomosis and esophageal repair for large tracheoesophageal fistulas; one required aortic wall reinforcement with a patch; one underwent endoscopic removal with a sternal split to explore the aortic arch. All 22 patients survived and recovered clinically. One developed bilateral vocal cord palsy as a complication.

Effective management of DB ingestion complications necessitates a collaborative, multidisciplinary approach. Our protocol has improved management strategies and patient outcomes.

A 2023 product recall has described the risk for morbidity and mortality for children ingesting water beads. We aimed to describe water bead exposure and management trends in the United States. We used the National Electronic Injury Surveillance System (NEISS) to identify water bead injuries from 2013 to 2023. Inclusion criteria were ages 0-17 years, diagnosis of ingested object/foreign body, and the narrative word(s) suggested water bead(s). NEISS supplied weights and variance variables to generate national estimates. There were 226 water bead injuries (66% ingestion). Children under age 2 years comprised 29% of injuries. Multiple water beads were involved in 56% of cases. There was a significant uptrend in water bead injury frequency after 2020. Sixteen (7%) cases required escalation of care. Water bead injuries are rising and appear to affect children of all ages. Children aged less than 5 years appear most vulnerable.

The ingestion of magnets used in toys and household products is a common problem in children and can have potentially devastating health consequences. The attraction between multiple magnets across intestinal walls can lead to bowel obstruction, fistula formation, necrosis, and perforation of the involved segments. Multiple magnets attached to each other within the intestinal lumen can also pass spontaneously. Clinical and radiological findings help guide the clinician in deciding whether to intervene surgically or follow an expectant management plan. We report the radiological finding of a "signet ring" on a plain abdominal X-ray that was associated with the surgical finding of fistula formation in two patients, who had clinically benign exams after magnet ingestion. This finding on plain abdominal X-rays should warrant operative exploration in children after magnet ingestion.

Foreign body ingestions commonly occur in children aged under 6 years. While serious complications of ingestions are rare, sharp objects, caustics, multiple magnets, and button batteries can be associated with poorer outcomes including gastrointestinal (GI) obstruction, perforation, necrosis, and fistula formation. Initial workup should include history, physical examination, and plain film radiographs that will identify radiopaque objects. Removal of the foreign body is typically warranted if the object is high risk, it is located higher up in the GI tract, the patient is symptomatic, or the object is retained for a prolonged amount of time.

It is important to note that prevention of button battery ingestion is the most effective way to reduce its incidence and complications. This is unachievable without providing educational plans for parents. Moreover, triage nurses and first-line staff who take the history of patients and physicians should take the history to evaluate the risk of battery ingestion. Plain radiographs can be helpful in this matter, as the presence of "Hallow" and "Steep" signs in the anteroposterior and lateral views, respectively, can help.

Foreign body ingestion is a relatively common occurrence in pediatrics, especially among children 1-3 years of age. Although most cases are benign and managed conservatively, those with high-risk subjects such as button batterie can bring about fatal conditions in the minority of cases. In the present study, the history, diagnostic, and therapeutic procedures of a 13-month-old baby with the final diagnosis of button battery ingestion are presented. The parents ignored the symptoms, suspecting that it was a viral infection. The evaluations showed that a battery was lodged in the middle part of the thoracic esophagus, which was removed by an urgent endoscopic procedure. The patient was under observation and on a nothing-by-mouth diet for a week, receiving nutritional fluid with a nasogastric tube. The necrosis, which was obvious after the removal of the battery, was healing in the second control esophagogastroduodenoscopy performed 1 week after the procedure. The stricture was minimal, and no need for dilation was diagnosed. This case report underscores the importance of a timely diagnosis and removal of these cases. This case underscores the importance of the timely presentation of these cases to health care and the risk of delayed removal, such as necrosis, forming fistula, and perforation of the esophagus. The delay can cause necrosis, fistula, and perforation and might lead to irreversible severe complications and even death.

Ingestion of magnets carries risks for significant morbidity. We propose a new protocol designed to reduce the need for surgery, shorten length of stay, and decrease morbidity.

The Early Colonic-preparation and Salvage Laparoscopic Appendectomy (ECSLA) protocol includes initiating colonoscopy preparation upon admission in asymptomatic patients if magnets are not amenable to removal by gastroscopy, and laparoscopic magnets retrieval via appendectomy if surgery is eventually needed. The protocol was initiated in May 2023. A retrospective study of all cases of ingested magnets in children in our institution during July 2020 - January 2024 was conducted to retrieve and analyze demographic, clinical, imaging, management, and outcome data.

During the 3.5-year study period, 13 cases of ingested multiple magnets were treated, including 7 cases since initiation of ECLSA protocol, with no complications. Since initiation of ECSLA protocol, Early colonic preparation resulted in spontaneous passage of magnets (two cases) and successful colonocsopic removal (three cases), with two cases in which magnets were retrieved via gastroscopy upon admission, and no patients needing surgical intervention. Length of stay (LOS) was short (1-3 days).

The ECSLA protocol is a promising tool for preventing surgical intervention and complications and for possibly shortening LOS in children who have ingested multiple magnets.

Foreign body ingestion in children is a frequent cause for medical consultation. Although most foreign bodies are spontaneously eliminated from the gastrointestinal tract, life-threatening complications such as gastrointestinal obstruction or perforation can occur. We report the case of a 6-year-old boy who died 2 days after the onset of nausea and abdominal pain, with no foreign body ingestion witnessed or reported in the previous days. Autopsy showed a diffuse peritonitis and a perforation of the transverse colon caused by three high-powered magnets stacked together, and attached to the outer stomach wall via a fourth magnet located in the stomach. The cause of death was peritonitis due to bowel perforation by ingested magnets, which were shown to have come from a toy belonging to the child. Ingestion of multiple high-powered magnets carries a high risk of gastrointestinal complications and can exceptionally have a fatal outcome, especially as it often goes unreported and causes non-specific gastrointestinal symptoms that can delay diagnosis and management. This case highlights the need to raise public awareness of the potential risks of ingesting such magnets and to strengthen safety standards to protect children from this serious health hazard.

The current state of policy-making necessitates clinicians and their organizations to be more engaged. This article provides practical examples of how to engage in various levels of advocacy within pediatric gastroenterology.

The incidence of foreign body ingestion in young children has been increasing over the past couple of years. Although less than 1% of ingested foreign bodies require surgical intervention, the clinician's awareness should be heightened when the ingested body has a magnetic component. Potential complications of multiple magnetics include intestinal necrosis, perforation, ileus, and sepsis. This case study highlights the clinical presentation, surgical methods, anesthetic considerations, and the need for pediatric intensive care unit (PICU) admission in a two-year-old female child who ingested magnetic beads. The paper presents the patient's history, diagnosis, and surgical procedure, including the use of a novel magnetic apparatus to locate the foreign bodies. Clinicians should have a heightened sense of caution when treating children who have ingested multiple magnetic foreign bodies due to potential gastrointestinal complications and increased morbidity. The case describes the use of a novel approach in utilizing a pacemaker magnet to identify any remaining ingested magnetic foreign bodies in the bowel.

Anesthesia is required for endoscopic removal of esophageal foreign bodies (EFBs) in children. Historically, endotracheal intubation has been the de facto gold standard for airway management in these cases. However, as more elective endoscopic procedures are now performed under propofol sedation with natural airway, there has been a move toward using similar Monitored Anesthesia Care (MAC) for select patients who require endoscopic removal of an EFB.

In this single-center retrospective cohort study, we compared endoscopic EFB removal with either MAC or endotracheal intubation. Descriptive statistics summarized factors stratified by initial choice of airway technique, including intra- and postanesthesia complications and the frequency of mid-procedure conversion to endotracheal intubation in those initially managed with MAC. To demonstrate the magnitude of associations between these factors and the anesthesiologist's choice of airway technique, univariable Firth logistic and quantile regressions were used to estimate odds ratios (95% CI) and beta coefficients (95% CI).

From the initial search, 326 patients were identified. Among them, 23% (n = 75) were planned for intubation and 77% (n = 251) were planned for MAC. Three patients (0.9%) who were initially planned for MAC required conversion to endotracheal intubation after induction. Two (0.6%) of these children were admitted to the hospital after the procedure and treated for ongoing airway reactivity. No patient experienced reflux of gastric contents to the mouth or dislodgement of the foreign body to the airway, and no patient required administration of vasoactive medications or cardiopulmonary resuscitation. Patients had higher odds that the anesthesiologist chose to utilize MAC if the foreign body was a coin (OR, 3.3; CI, 1.9-5.7, p < .001) or if their fasting time was >6 h. Median total operating time was 15 min greater in intubated patients (11 vs. 26 min, p < .001).

This study demonstrates that MAC may be considered for select pediatric patients undergoing endoscopic removal of EFB, especially those who have ingested coins, who do not have reactive airways, who have fasted for >6 h, and in whom the endoscopic procedure is expected to be short and uncomplicated. Prospective multi-site studies are needed to confirm these findings.

Foreign bodies (FBs) in pediatric otorhinolaryngology represent up to 10% of cases in emergency departments (ED) and are primarily present in children under five years old. They are probably the result of children's curiosity and tendency to explore the environment. Aural and nasal FBs are the most common and accessible, and the removal methods differ depending on the exact location and type of FB, which can be organic or inorganic. A fish bone stuck in one of the palatine tonsils is the most common pharyngeal FB. Laryngopharyngeal FBs can obstruct the upper respiratory tract and thus become acutely life-threatening, requiring an urgent response. Aspiration of FBs is common in children between 1 and 4 years old. A history of coughing and choking is an indication of diagnostic and therapeutic methods to rule out or confirm a tracheobronchial FB. Regardless of the availability of radiological diagnostics, rigid bronchoscopy is the diagnostic and therapeutic method of choice in symptomatic cases. Radiological diagnostics are more significant in treating esophageal FBs since most are radiopaque. Flexible or rigid esophagoscopy is a successful method of removal. A delayed diagnosis, as with tracheobronchial FBs, can lead to fatal consequences.

To analyze the clinical characteristics of esophageal button battery impactions in children and explore safe and effective treatment methods.

This retrospective cohort study was conducted at a single tertiary care center, Shenzhen Children's Hospital, encompassing 89 children diagnosed with esophageal button battery impactions between January 2013 and January 2023. To minimize esophageal mucosal corrosion, prompt removal of the button battery with a first-aid fast track rigid esophagoscopy under general anesthesia was performed within thirty minutes of diagnosis. The clinical features and complications were recorded and analyzed.

Button battery as esophageal foreign body was prevalent among children under 3 years old (79.8%), with boys exhibiting a higher incidence rate (56.2%) compared to girls (43.8%), and an average age of 25.8 months. The median duration from ingestion to hospital admission was 3 h (range: 0.5 h to 3 months). Common symptoms included vomiting and dysphagia, with early stage vomiting of brown foamy secretions being a characteristic presentation of esophageal button battery impactions. The majority (77.5%) of batteries were lodged in the upper esophagus. The larger batteries were verified to be more prone to complications. All 89 cases exhibited varying degrees of esophageal mucosal erosion, with 31 cases (34.8%) experiencing severe complications, including esophageal stenosis in 11 cases (35.5%), esophageal perforation in 9 cases (29%) with 4 cases of tracheoesophageal fistula, vocal cord paralysis in 6 cases (19.4%), hemorrhage in 2 cases (6.5%), mediastinitis in 2 cases (6.5%), and periesophageal abscess in 1 case (3.2%). Despite the severity of these complications, none of the patients died after emergency surgery.

Esophageal button battery impactions can lead to significant damage to the esophageal mucosa due to its strong corrosiveness. Prompt action is crucial to mitigate the risk of complications. For the first time, we implement a first-aid fast track surgical intervention following diagnosis is imperative to minimize the incidence of adverse outcomes.

Esophageal food impaction (EFI) is the sudden onset of dysphagia that occurs when a food bolus becomes lodged in the esophagus, requiring endoscopic removal. Scientific data on the prevalence and causes of EFI in children is lacking. The aim of this study was to provide further insights into EFI episodes in children.

We have prospectively enrolled all children admitted for a first episode of EFI between March 2018 and March 2023. A fluoroscopic contrast study was performed in all patients to confirm the boluses and assess their position. Boluses were extracted by esophagogastroduodenoscopies, and esophageal biopsies were routinely obtained for histologic evaluation.

Over the study period, 41 children were admitted for a first episode of food impaction. Drooling was the most commonly reported symptom. Half children experiencing a first episode of food bolus were diagnosed with EoE (20/41, 48.8%). Almost a fourth of the episodes subtended a different condition, such as esophageal anastomotic, peptic or congenital strictures, stricturing caustic esophagitis, esophageal duplication, and achalasia. In the last fourth of patients the cause of EFI was not identified and thus probably related to quick eating and inadequate chewing of food.

Our study represents the largest known series of pediatric patients evaluated for food bolus impaction. Our main finding is the high frequency of EoE, which accounts for a half of EFI episodes in pediatric age, especially in older children. This finding highlights the importance of obtaining esophageal biopsies after the endoscopic bolus removal in children with EFI to provide a complete diagnostic evaluation.