{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T03:43:16Z","timestamp":1782963796033,"version":"3.54.5"},"reference-count":19,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2019,3,5]],"date-time":"2019-03-05T00:00:00Z","timestamp":1551744000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives\/Hypothesis<\/jats:title>\n                    <jats:p>Pediatric esophageal button battery (BB) injuries can progress even after removal and continue to be a significant source of morbidity and mortality. The objective in this case series is to present initial safety data for the human application of intraoperative tissue pH neutralization using 0.25% acetic acid irrigation after BB removal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective case series.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Pediatric patients who underwent rigid esophagoscopy for BB removal between October 2016 and December 2017 and who had the injury site irrigated with 120 to 150\u2009mL sterile 0.25% acetic acid (pH\u2009=\u20093) were included in the study. Outcome measures included visual tissue appearance after irrigation, immediate or delayed esophageal perforation, and evidence of eventual esophageal stricture formation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six pediatric patients (aged 19\u2009months\u201310\u2009years) had a 3\u2009V lithium BB lodged in the esophagus for 2 to 18\u2009hours and had irrigation of the esophageal injury site with sterile 0.25% acetic acid in the operating room after BB removal. None of the patients showed any evidence of thermal tissue injury. By surgeon assessment, all cases had improved visual esophageal tissue appearance. Neither immediate post\u2010operative or delayed onset esophageal perforation nor eventual stricture development were seen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Esophageal irrigation in the operating room with sterile 0.25% acetic acid after BB removal, to neutralize the highly alkaline tissue microenvironment (pH\u200910\u201313) was safe and resulted in improved visual mucosal appearance. This immediate tissue pH neutralization may help halt the progression of liquefactive necrosis by immediately bringing tissue pH to physiologic range. This post\u2010removal irrigation technique is recommended by current National Capital Poison Center BB guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>4<\/jats:p>\n                    <jats:p>\n                      <jats:italic>Laryngoscope<\/jats:italic>\n                      , 129:1772\u20131776, 2019\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.27904","type":"journal-article","created":{"date-parts":[[2019,3,5]],"date-time":"2019-03-05T22:03:27Z","timestamp":1551823407000},"page":"1772-1776","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Initial clinical application of tissue pH neutralization after esophageal button battery removal in children"],"prefix":"10.1002","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8475-9780","authenticated-orcid":false,"given":"Kris R.","family":"Jatana","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Nationwide Children's Hospital and Wexner Medical Center at Ohio State University  Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7248-8979","authenticated-orcid":false,"given":"Christine L.","family":"Barron","sequence":"additional","affiliation":[{"name":"The Ohio State University College of Medicine  Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian N.","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology The Children's Hospital of Philadelphia  Philadelphia Pennsylvania"},{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania, U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,3,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009-3037"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2013.06.006"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2018.08.009"},{"key":"e_1_2_7_5_1","unstructured":"National Poison Data System and National Battery Ingestion Hotline:button battery ingestions frequency and severity for moderate major and fatal outcomes 1985\u20102017. Available at:http:\/\/www.poison.org\/battery\/stats.asp. Accessed May 12 2018."},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26362"},{"key":"e_1_2_7_7_1","unstructured":"National Capital Poison Center button battery ingestion triage and treatment guideline. Available at:https:\/\/www.poison.org\/battery\/guideline. 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