X-ray after foreign body removal by esophagoscopy is not cost effective

Image: PD

1. Chest radiograph was unsuccessful in diagnosing pediatric esophageal injuries. 

2. Contrast esophagram is preferred over a chest radiograph to confirm suspicion of injury on esophagoscopy. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Hundreds of thousands of children swallow foreign objects each year. Rigid esophagoscopy is commonly used to remove these objects. The lodged article is extracted with the scope and then the scope is reinserted to evaluate for injury to the esophagus and to determine if lingering foreign bodies are present. In addition to the second evaluation, some surgeons choose to obtain a chest radiograph to evaluate for esophageal perforation. Investigators focused on evaluating the effectiveness of chest radiographs in this specific situation. Results displayed that out of all chest radiographs performed, no positive findings were discovered. Esophagram was significantly more likely to uncover an esophageal injury vs. chest radiograph. Absence of positive findings on esophagram was a strong indicator that there was not any injury present in the esophagus with a negative predictive value of 100%. All objects removed were noted and batteries prompted a high suspicion of injury. The findings of this study could be limited by its lack of including uncommon presentations of this problem, and by the absence of a dedicated follow-up.

Click to read the study, published today, in Pediatrics

Relevant Reading: Esophageal Foreign Bodies in Pediatric Patients: A Thirteen-Year Retrospective Study

In-Depth [retrospective cohort study]: The records of 690 children at Children’s Healthcare of Atlanta, Egleston, were examined between May 2000 and December 2010 to evaluate assessment of esophageal foreign bodies. Medical records evaluated included clinical notes, imaging reports, and operative reports. Children with previous foregut surgery or any anatomic abnormality were excluded. A total of 105 children had operative findings consistent with an esophageal injury. These children were significantly more likely to have an injury diagnosed by esophagram rather than by chest radiograph (8.5% vs. 0%, p = 0.0001). Nine had confirmed esophageal injury, but none of these injuries were seen on chest radiograph. No positive findings were seen on chest radiograph, whether conducted routinely or on suspicion of injury (sensitivity 0%). Batteries accounted for only 2% of all objects swallowed, but were responsible for 30% of all serious injuries documented. A total of $34.30 in coins was removed from this cohort. 

By Brandon Childs and Devika Bhushan

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