ABSTRACT
Foreign body and caustic ingestions in children are usually the most common clinical
challenges for emergency physicians, general pediatricians and pediatric gastroenterologists.
Management of these conditions often requires different levels of expertise and competence.
Endoscopy is often necessary but there is a high risk of misusing this tool with incorrect
timing and indications. The imprecise clinical history frequently leaves clinicians
uncertain about timing and nature of the ingestion. Few clinical guidelines regarding
management of these ingestions in children have been published, none of which from
the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP).
An expert panel of Italian endoscopists was convened by the SIGENP Endoscopy Working
Group to produce the present article that outlines practical clinical approaches to
the pediatric patient with a variety of foreign body and caustic ingestions. The Italian
Association of Hospital Gastroenterologists and Endoscopists (AIGO) has also endorsed
the project since many adult endoscopists usually manage children with these conditions.
Differently from the other published guidelines, the proposed one focuses on the role
of the endoscopists (regardless of whether they are adult or pediatric gastroenterologists)
in the diagnostic process of children with foreign body and caustic ingestions.
Keywords
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References
- The pediatric endoscopy practice in Italy: a nationwide survey on behalf of the Italian society of pediatric gastroenterology, hepatology and nutrition (SIGENP).Dig Liver Dis. 2019; 51: 1203-1206
- Does the Structure of Clinical Questions Affect the Outcome of Curbside Consultations With Specialty Colleagues?.Arch Fam Med. 2000; 9: 541-547
- Grading quality of evidence and strength of recommendations.BMJ. 2004; 328: 1490
- Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee.J Pediatr Gastroenterol Nutr. 2015; 60: 562-574
- Pediatric gastrointestinal endoscopy: european Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive summary.Endoscopy. 2017; 49: 83-91
- Developing the Pediatric Gastrointestinal Endoscopy Unit: a Clinical Report by the Endoscopy and Procedures Committee.J Pediatr Gastroenterol Nutr. 2016; 63: 295-306
- Foreign object ingestion and esophageal food impaction: an update and review on endoscopic management.World J Gastrointest Endosc. 2019; 11: 174-192
- Endoscopic management of foreign bodies in the upper gastrointestinal tract: a review.World J Gastrointest Endosc. 2014; 6: 475-481
- SGNA position statement on minimal registered nurse staffing for patient care in the gastrointestinal endoscopy unit.Gastroenterol Nurs. 2002; 25: 269-270
- Setting up the Pediatric Endoscopy Unit.Gastrointest Endosc Clin N Am. 2016; 26: 1-12
- Paediatric Gastrointestinal Endoscopy: european Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy Guidelines.J Pediatr Gastroenterol Nutr. 2017; 64: 133-153
- Removal of foreign bodies in the upper gastrointestinal tract in adults: european Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.Endoscopy. 2016; 48: 489-496
- Endoscopic retrieval devices.Gastrointest Endosc. 2009; 69: 997-1003
- Foreign-Body Ingestions of Young Children Treated in US Emergency Departments: 1995-2015.Pediatrics. 2019; 143
- Foreign body injuries in children: a review.Acta Otorhinolaryngol Ital. 2015; 35: 265-271
- Foreign Body Ingestion in Children.Clin Endosc. 2018; 51: 129-136
- Management of ingested foreign bodies and food impactions.Gastrointest Endosc. 2011; 73: 1085-1091
- A systematic review of paediatric foreign body ingestion: presentation, complications, and management.Int J Pediatr Otorhinolaryngol. 2013; 77: 311-317
- Management of ingested foreign bodies in childhood and review of the literature.Eur J Pediatr. 2001; 160: 468-472
- Clinical guidelines for imaging and reporting ingested foreign bodies.AJR Am J Roentgenol. 2014; 203: 37-53
- Updates in pediatric gastrointestinal foreign bodies.Pediatr Clin North Am. 2013; 60: 1221-1239
- 2016 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th Annual Report.Clin Toxicol (Phila). 2017; 55: 1072-1252
- Emerging battery-ingestion hazard: clinical implications.Pediatrics. 2010; 125: 1168-1177
- Preventing battery ingestions: an analysis of 8648 cases.Pediatrics. 2010; 125: 1178-1183
- Severe gastric damage caused by button battery ingestion in a 3-month-old infant.J Pediatr Surg. 2010; 45: e23-e26
- Management of button battery-induced hemorrhage in children.J Pediatr Gastroenterol Nutr. 2011; 52: 585-589
- A randomized clinical trial of the management of esophageal coins in children.Pediatrics. 2005; 116: 614-619
- Coin ingestion in children: which size is more risky?.J Laparoendosc Adv Surg Tech A. 2009; 19: 241-243
- Foreign body injury in children in the twentieth century: a modern comparison to the Jackson collection.Int J Pediatr Otorhinolaryngol. 2003; 67: S171-S174
- Foreign body ingestions in children: risk of complication varies with site of initial health care contact.Pediatric Practice Research Group. Pediatrics. 1993; 91: 121-127
- Ingested foreign bodies causing complications and requiring hospitalization in European children: results from the ESFBI study.Pediatr Int. 2010; 52: 26-32
- Foreign-body ingestion: characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion.Gastrointest Endosc. 2009; 69: 426-433
- Laparoscopic removal of ingested pin penetrating the gastric wall in an immunosuppressed patient.Surg Endosc. 2004; 18: 870
- Pediatric foreign bodies and their management.Curr Gastroenterol Rep. 2005; 7: 212-218
- pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury.Laryngoscope. 2019; 129: 49-57
- Timing of Button Battery Removal From the Upper Gastrointestinal System in Children.Pediatr Emerg Care. 2018;
- Management of ingested magnets in children.J Pediatr Gastroenterol Nutr. 2012; 55: 239-242
- Disk battery ingestion: high clinic risk.Ital J Pediatr. 2015; 41 (1824-7288-41-S2-A27): A27
National Capital Poison Center button battery ingestion triage and treatment guidelinehttps://www.poison.org/battery/guideline.
- Lithium battery lodged in the oesophagus: a report of three paediatric cases.Dig Liver Dis. 2015; 47: 984-986
- Basic mechanism of button battery ingestion injuries and novel mitigation strategies after diagnosis and removal.Laryngoscope. 2017; 127: 1276-1282
- Imaging button battery ingestions and insertions in children: a 15-year single-center review.Pediatr Radiol. 2017; 47: 178-185
- Foreign body ingestion: comparison of diagnostic accuracy of computed tomography versus endoscopy.J Laryngol Otol. 2009; 123: 535-540
- Esophageal food impaction: epidemiology and therapy. A retrospective, observational study.Gastrointest Endosc. 2001; 53: 193-198
- Retrospective analysis of esophageal food impaction: differences in etiology by age and gender.Dig Dis Sci. 2007; 52: 717-721
- Esophageal eosinophilia in children with dysphagia.J Pediatr Gastroenterol Nutr. 2003; 37: 498-503
- Esophageal food impaction in children.Pediatr Emerg Care. 2003; 19: 402-407
- Food Bolus Impaction in the Era of Increased EoE Recognition: push and Pull, Biopsy and Dilate Before It Is Too Late.Dig Dis Sci. 2018; 63: 1371-1373
- Conservative management of oesophageal soft food bolus impaction.Cochrane Database Syst Rev. 2020; 5 (CD007352)
- The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis.Clin Gastroenterol Hepatol. 2012; 10 (e5): 988-996
- Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults.United European Gastroenterol J. 2017; 5: 335-358
- Caustic ingestion.Lancet. 2017; 389: 2041-2052
- Esophageal emergencies: WSES guidelines.World J Emerg Surg. 2019; 14: 26
- Caustic ingestion in children: is endoscopy always indicated? The results of an Italian multicenter observational study.Gastrointest Endosc. 2008; 68: 434-439
- Oesophageal corrosive injuries in children: a forgotten social and health challenge in developing countries.Bull World Health Organ. 2009; 87: 950-954
- Pediatric caustic ingestion: 50 consecutive cases and a review of the literature.Dis Esophagus. 2009; 22: 89-94
- Update on management of caustic and foreign body ingestion in children.Diagn Ther Endosc. 2009; 2009969868
- Caustic oesophagitis in children: prevalence, the corrosive agents involved, and management from primary care through to surgery.Curr Opin Otolaryngol Head Neck Surg. 2015; 23: 423-432
- Evaluation and management of caustic injuries from ingestion of Acid or alkaline substances.Clin Endosc. 2014; 47: 301-307
- A single center experience of self-bougienage on stricture recurrence after surgery for corrosive esophageal strictures in children.Yonsei Med J. 2010; 51: 202-205
- Conservative management of caustic substance ingestion in a pediatric department setting, short-term and long-term outcome.Dis Esophagus. 2011; 24: 86-91
- Is esophagogastroduodenoscopy necessary in all caustic ingestions?.J Pediatr Gastroenterol Nutr. 2001; 32: 50-53
- Ingestion of acid and alkaline agents: outcome and prognostic value of early upper endoscopy.Gastrointest Endosc. 2004; 60: 372-377
- Controversies in the management of caustic ingestion injury: an evidence-based review.Clin Otolaryngol. 2017; 42: 701-708
- Accidental caustic ingestion in children: is endoscopy always mandatory?.J Pediatr Gastroenterol Nutr. 2001; 33: 81-84
- A standardised protocol for the acute management of corrosive ingestion in children.Pediatr Surg Int. 2004; 20: 824-828
- Initial signs and symptoms as prognostic indicators of severe gastrointestinal tract injury due to corrosive ingestion.J Emerg Med. 2007; 33: 349-353
- Predictability of outcome of caustic ingestion by esophagogastroduodenoscopy in children.World J Gastroenterol. 2012; 18: 1098-1103
- The conservative management of severe caustic gastric injuries.Ann Surg. 2011; 253: 684-688
- Computed tomography evaluation of high-grade esophageal necrosis after corrosive ingestion to avoid unnecessary esophagectomy.Surg Endosc. 2015; 29: 1452-1461
- Factors predicting the hospital mortality of patients with corrosive gastrointestinal injuries receiving esophagogastrectomy in the acute stage.World J Surg. 2010; 34: 2383-2388
- Computed Tomography Evaluation of Esophagogastric Necrosis After Caustic Ingestion.Ann Surg. 2016; 264: 107-113
- Caustic Ingestion in Children: one Year Experience in Three Italian Referral Centers [published online ahead of print, 2020 Mar 5].J Pediatr Gastroenterol Nutr. 2020; (10.1097/MPG.0000000000002685)
- [Ingestion of caustic substances: an analysis of the safety and benefit of a less aggressive protocol].An Pediatr (Barc). 2019; 90: 207-212
- Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion.World J Emerg Surg. 2015; 10: 48
- Caustic injury: can CT grading system enable prediction of esophageal stricture?.Clin Toxicol (Phila). 2010; 48: 137-142
- The role of chest and abdominal computed tomography in assessing the severity of acute corrosive ingestion.Clin Toxicol (Phila). 2013; 51: 834-837
- Should computerised tomography replace endoscopy in the evaluation of symptomatic ingestion of corrosive substances?.Clin Toxicol (Phila). 2014; 52: 911-925
- Miniprobe ultrasonography for determining prognosis in corrosive esophagitis.Am J Gastroenterol. 2004; 99: 851-854
- Microstream capnography improves patient monitoring during moderate sedation: a randomized, controlled trial.Pediatrics. 2006; 117: e1170-e1178
- The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns.Gastrointest Endosc. 1991; 37: 165-169
- Caustic ingestion in adults: the role of endoscopic classification in predicting outcome.BMC Gastroenterol. 2008; 8: 31
- Predicting the progress of caustic injury to complicated gastric outlet obstruction and esophageal stricture, using modified endoscopic mucosal injury grading scale.Biomed Res Int. 2014; 2014919870
- Diagnosis and management of iatrogenic endoscopic perforations: european Society of Gastrointestinal Endoscopy (ESGE) Position Statement.Endoscopy. 2014; 46: 693-711
- Case report: pharyngolaryngeal stenosis in a child due to caustic ingestion treated with transoral CO2 laser microsurgery.Ann Otol Rhinol Laryngol. 2014; 123: 847-851
- Caustic gastroesophageal lesions in childhood: an analysis of 473 cases.Clin Pediatr (Phila). 2006; 45: 435-438
- Minimally invasive management of children with caustic ingestion: less pain for patients.Pediatr Surg Int. 2010; 26: 251-255
- Caustic Ingestions and Foreign Bodies Ingestions in Pediatric Patients.Pediatr Clin North Am. 2017; 64: 507-524
- High doses of methylprednisolone in the management of caustic esophageal burns.Pediatrics. 2014; 133: E1518-E1524
- Role of early endoscopic evaluation in decreasing morbidity, mortality, and cost after caustic ingestion: a retrospective nationwide database analysis.Dis Esophagus. 2017; 30: 1-11
- Caustic injury of the upper gastrointestinal tract: a comprehensive review.World J Gastroenterol. 2013; 19: 3918-3930
- Caustic ingestion in children-A review.Semin Pediatr Surg. 2017; 26: 95-104
- Corrosive esophagitis in children: a 30-year review.Int J Pediatr Otorhinolaryngol. 2001; 57: 203-211
- Corrosive esophagitis in children.Pediatr Surg Int. 2004; 20: 207-210
- Role of endoscopy in caustic injury of the esophagus.World J Gastrointest Endosc. 2018; 10: 274-282
- Aggressive bougie dilatation and intralesional steroids is effective in refractory benign esophageal strictures secondary to corrosive ingestion.Dis Esophagus. 2016; 29: 1027-1031
- Topical mitomycin C application is effective in management of localized caustic esophageal stricture: a double-blinded, randomized, placebo-controlled trial.J Pediatr Surg. 2013; 48: 1621-1627
- Topical Mitomycin C application in the treatment of refractory benign esophageal strictures in adults and comprehensive literature review.Dig Liver Dis. 2016; 48: 1058-1065
- Natural history and management of refractory benign esophageal strictures.Gastrointest Endosc. 2016; 84: 222-228
Article info
Publication history
Published online: August 08, 2020
Accepted:
July 17,
2020
Received:
June 21,
2020
Identification
Copyright
© 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
