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Author Notes:

Elizabeth M. Sinclair, MD, FAAP, Emory University, Pediatric Divisions of Gastroenterology, Hepatology, and Nutrition, Emory Children’s Center, 2015 Uppergate Dr. NE, Atlanta, GA 30322, Phone: 404-727-0903. Email: elizsinc@gmail.com

Dr. Sinclair composed the bulk of the introduction and discussion drafted the initial manuscript, and reviewed and revised the manuscript. Dr. Santore provided surgical perspective of the hospital course and contributed to the section on battery removal and discussion and reviewed and revised the manuscript. Dr. Agarwal provided emergency provider perspective especially in regards to initial presentation and care and injury prevention and reviewed and revised the manuscript. Drs Kitzman contributed to the sections on anesthesiology and sedation and reviewed and revised the manuscript. Dr. Sauer contributed the gastroenterology perspective especially in regards to current guidelines and also reviewed and revised the manuscript. Dr. Riedesel contributed to the sections on imaging and reviewed and revised the manuscript. All authors attest that they meet the current ICMJE criteria for Authorship.

We would like to thank Dr. Elizabeth Saunders for assistance in preparing this manuscript.

The authors have no conflicts of interest relevant to this article to disclose.


Research Funding:

The project described was supported by Award Number T32DK108735 from the National Institute of Diabetes and Digestive and Kidney Diseases. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases or the National Institutes of Health.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Gastroenterology & Hepatology
  • Nutrition & Dietetics
  • Pediatrics
  • button battery
  • esophagus
  • foreign body

Evolving Clinical Care in Esophageal Button Batteries: Impact of Expert-Opinion Guideline Adoption and Continued Gaps in Care


Journal Title:



Volume 74, Number 2


, Pages 236-243

Type of Work:

Article | Post-print: After Peer Review


Background/Objectives:Esophageal button battery impactions (BBI) in children pose a significant danger to children. Although there are expert-opinion guidelines to help manage this population, few studies detail the impact of guidelines on the clinical care of these patients. With this study, we aimed to describe the care of these patients before and following adoption of guidelines at a single center.Methods:Retrospective cohort study of patients with esophageal BBI at a single center, large volume, urban academic pediatric hospital system before adoption of expert-opinion guidelines (2007-2017) and following adoption (2018-2020).Results:Cohort was comprised of 31 patients before adoption and 32 patients following adoption of guidelines. Patient characteristics did not differ between groups. After 2018, significantly more patients received acetic acid irrigation, initial cross-sectional imaging, and serial cross-sectional imaging. There was also an increase in intensive care unit (ICU) stays, number of intubations, nil per os time, and hospital length of stay. There was no difference in patient outcomes.Conclusion:This study describes a large cohort of pediatric esophageal BBI before and following adoption of guidelines. Findings detail increased adherence to guidelines resulting in more cross-sectional imaging which led to ICU stays, longer length of stays, and more nil per os time. This study emphasizes the need for multi-disciplinary guidelines as well as further multi-institutional study.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/).
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