April 23, 2020
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Delayed removal of swallowed button batteries in kids may further damage the stomach

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Children who swallow button batteries are more likely to experience gastric damage if the object is removed 12 or more hours after ingestion, according to research published in Gastrointestinal Endoscopy.

Racha T. Khalaf, MD, of the digestive health institute at Children’s Hospital Colorado, and colleagues wrote that while button battery ingestions are generally thought to be more threatening when they are located in the esophagus, there is no universal recommendation for batteries that are retained in the stomach.

“Gastric button batteries are generally thought to be less damaging due to the larger stomach size, increased thickness, and decreased number of closely associated anatomic structures,” they wrote. “Timing, urgency, and indication for removal of a button battery beyond the lower esophageal sphincter have been controversial.”

To better define the scope of potential injuries caused by gastric button batteries and describe clinical factors associated with those injuries, researchers conducted a retrospective cohort study comprising 68 pediatric patients (median age, 2.5 years) who had retained a gastric button battery located on radiography and later removed through endoscopic intervention.

The patients had a median duration from ingestion to removal of battery of 9 hours (interquartile range, 5-19 hours) and median time from ingestion to first radiographic evaluation of 2 hours. Only one quarter of the patients were symptomatic at the time of presentation.

Investigators found that at endoscopic assessment, 60% of patients had visual evidence of mucosal damage, which correlated with the duration of battery retention (P = .0018). After adjusting for age and symptoms, they found that the likelihood of visualizing gastric damage among patients who had their batteries removed at least 12 hours after ingestion was 4.5 times that compared with patients who had their batteries within 12 hours of ingestion.

Because of risk for damage to the stomach, Khalaf and colleagues wrote that clinicians may want to consider gastric button battery retrieval within 12 hours of ingestion.

“Gastric retention can offer risks of serious serosal injury and perforation,” they wrote. “Imaging studies should be interpreted and carefully reviewed with an experienced radiologist in order to ascertain battery location within the intestinal tract.” – by Alex Young

Disclosure: Healio Gastroenterology and Liver Disease could not confirm the authors’ relevant financial disclosures prior to publication.