Gastric Button Battery – Emergent Scope?

March 23, 2018

Spoon Feed
This single-center series found button batteries (BB) lodged in the esophagus all caused mucosal injury, but those in the stomach also caused mucosal injury in 6 out of 12.  We may need to rethink the urgency of retrieving gastric BB.

Why does this matter?
BB ingestion can cause severe mucosal injury when lodged in the esophagus for a very brief time.  This is a surgical emergency and must be removed within 2 hours.  Classic teaching is that once the battery has passed into the stomach, there is less urgency.  So if it is in the stomach, can we relax?

Esophageal button battery = surgical emergency
This was one of the largest case series to date, totaling 25 patients with BB ingestion in Chile.  They found 10 in the esophagus, 12 in the stomach, and 3 were beyond the pylorus.  Half showed breakage around the edges of the battery.  All esophageal BB caused mucosal injury.  Half of those in the stomach caused mucosal injury: 1 necrosis (in an asymptomatic 2.5 year old), 1 erythema, and 4 erosions.  “Risk factors for developing mucosal damage in gastric BB have been previously described, including patients younger than 4 years, ingestion of 2 or more batteries, battery size greater than or equal to 20 mm, battery remaining in the same location for more than 48 hours or containing lithium, concomitant ingestion of magnets, unknown time since ingestion or the presence of symptoms.”  These authors recommend removal of gastric BB within 48 hours.  I present this not as a landmark paper but more as a reminder that esophageal BB is a surgical emergency.  And this study shows us that gastric BB also appears to need urgent removal as well.

Source
Endoscopic Findings Associated With Button Battery Ingestion in Children: Do We Need to Change the Protocol for Managing Gastric Location?  Pediatr Emerg Care. 2018 Jan 23. doi: 10.1097/PEC.0000000000001415. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.