{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T11:36:58Z","timestamp":1791805018919,"version":"4.3.4"},"reference-count":23,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2000,1,1]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>To compare clinical outcomes and costs under 4 strategies for the management of esophageal coins in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>We developed a decision analysis model of 4 possible strategies for managing esophageal coins: 1) endoscopic removal under general anesthesia; 2) esophageal bougienage, 3) an outpatient 12- to 24-hour observation period to allow spontaneous coin passage; and 4) an inpatient observation period. Probabilities of success and complication rates for endoscopy and esophageal bougienage were obtained from published data. The probability of spontaneous coin passage was derived from chart review data at our institution. Costs were calculated from charges using a cost-to-charge ratio of .72. Hypothetical patients included in the model were those with a single esophageal coin presenting within 24 hours of ingestion, with no respiratory compromise on presentation and with no previous history of esophageal disease. Strategy-specific outcomes were overall complication rate and total cost in dollars per patient. Sensitivity analyses were performed to account for variations in the data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>The esophageal bougienage strategy resulted in no complications and a total cost per patient of $382, which represents a marginal advantage of $2915 per patient compared with the endoscopic removal strategy. On sensitivity analysis over the range of success and complication rates of bougienage, this strategy maintained a considerable decrease in both overall complications and total cost per patient compared with all other strategies. Both outpatient and inpatient observation strategies had overall complication rates of 4.2% compared with the complication rate of 5.8% for the endoscopy strategy. The total cost per patient under these strategies was $2439 for the outpatient and $3141 for the inpatient strategy, representing a marginal advantage of $858 and $156 per patient, respectively, compared with the endoscopy strategy. Both observation strategies maintained a lower overall complication rate compared with endoscopy in the sensitivity analysis. The outpatient observation strategy maintained a marginal advantage of $645 to $1257 per patient compared with endoscopy; however, the inpatient observation strategy total cost per patient surpassed that of endoscopy at a spontaneous passage rate &amp;lt;23%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions.<\/jats:title><jats:p>Given the high success and low complication rates reported for esophageal bougienage, substantial savings in overall complications and costs would be expected with the use of this procedure. With spontaneous passage rates &amp;gt;23%, either an outpatient or an inpatient observation strategy would reduce costs and complications, compared with endoscopic removal of all esophageal coins.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.105.1.e5","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:50:41Z","timestamp":1092441041000},"page":"e5-e5","source":"Crossref","is-referenced-by-count":49,"title":["Four Strategies for the Management of Esophageal Coins in Children"],"prefix":"10.1542","volume":"105","author":[{"given":"Joyce V.","family":"Soprano","sequence":"first","affiliation":[{"name":"1 From the Division of Emergency Medicine, Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth D.","family":"Mandl","sequence":"additional","affiliation":[{"name":"1 From the Division of Emergency Medicine, Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2000,1,1]]},"reference":[{"key":"2021121010280453800_B1","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1136\/bmj.4.5785.469","article-title":"Management of ingested foreign bodies in childhood.","volume":"4","author":"Spitz","year":"1971","journal-title":"Br Med J"},{"key":"2021121010280453800_B2","first-page":"585","article-title":"Management of pediatric patients who have swallowed foreign objects.","volume":"55","author":"Suita","year":"1989","journal-title":"Am Surg"},{"key":"2021121010280453800_B3","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/bjs.1800650103","article-title":"Foreign body in the oesophagus: review of 2394 cases.","volume":"65","author":"Nandi","year":"1978","journal-title":"Br J Surg"},{"key":"2021121010280453800_B4","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/S0196-0644(84)80573-9","article-title":"Pediatric gastrointestinal foreign body ingestion.","volume":"13","author":"Binder","year":"1984","journal-title":"Ann Emerg Med"},{"key":"2021121010280453800_B5","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1136\/bmj.302.6788.1321","article-title":"Rationalising the management of swallowed coins in children.","volume":"302","author":"Stringer","year":"1991","journal-title":"Br Med J"},{"key":"2021121010280453800_B6","doi-asserted-by":"crossref","first-page":"236","DOI":"10.5694\/j.1326-5377.1963.tb26662.x","article-title":"Swallowed foreign bodies in childhood.","volume":"50","author":"Jones","year":"1963","journal-title":"Med J Aust"},{"key":"2021121010280453800_B7","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1001\/archpedi.1989.02150170047018","article-title":"Pediatric coin ingestions: a prospective study on the utility of routine roentgenograms.","volume":"143","author":"Caravati","year":"1989","journal-title":"Am J Dis Child"},{"key":"2021121010280453800_B8","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/S0196-0644(85)80289-4","article-title":"Coin ingestion: does every child need a radiograph?","volume":"14","author":"Hodge","year":"1985","journal-title":"Ann Emerg Med"},{"key":"2021121010280453800_B9","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/S0196-0644(84)80294-2","article-title":"Asymptomatic esophageal perforation by a coin in a child.","volume":"13","author":"Nahman","year":"1984","journal-title":"Ann Emerg Med"},{"key":"2021121010280453800_B10","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1177\/000348948209100320","article-title":"Tracheoesophageal fistula: a complication of foreign body.","volume":"91","author":"Obiako","year":"1982","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"2021121010280453800_B11","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1136\/bmj.2.5469.1042","article-title":"Foreign body in the oesophagus.","volume":"2","author":"Vella","year":"1965","journal-title":"Br Med J"},{"key":"2021121010280453800_B12","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/S0016-5107(93)70212-6","article-title":"Techniques and complications of esophageal foreign body extraction in children and adults.","volume":"39","author":"Berggreen","year":"1993","journal-title":"Gastrointest Endosc"},{"key":"2021121010280453800_B13","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1177\/000348949009901201","article-title":"Removal of blunt foreign bodies from the esophagus.","volume":"99","author":"Hawkins","year":"1990","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"2021121010280453800_B14","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1542\/peds.94.5.709","article-title":"Flouroscopic Foley catheter removal of esophageal foreign bodies in children: experience with 415 episodes.","volume":"94","author":"Schunk","year":"1994","journal-title":"Pediatrics"},{"key":"2021121010280453800_B15","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1016\/S0022-3468(88)80384-1","article-title":"Esophageal bougienage technique for coin ingestion in chldren.","volume":"23","author":"Bonadio","year":"1988","journal-title":"J Pediatr Surg"},{"key":"2021121010280453800_B16","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1016\/S0196-0644(96)70190-7","article-title":"Efficacy of esophageal bougienage by emergency physicians in pediatric coin ingestion.","volume":"27","author":"Emslander","year":"1996","journal-title":"Ann Emerg Med"},{"key":"2021121010280453800_B17","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1001\/archpedi.153.10.1073","article-title":"The spontaneous passage of esophageal coins in children.","volume":"153","author":"Soprano","year":"1996","journal-title":"Arch Pediatr Adolesc Med"},{"key":"2021121010280453800_B18","first-page":"173","article-title":"Foreign bodies of the esophagus.","volume":"51","author":"Chaikhouni","year":"1985","journal-title":"Am Surg"},{"key":"2021121010280453800_B19","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/00006565-199412000-00007","article-title":"Esophageal mucosal changes in children with an acutely ingested coin lodged in the esophagus.","volume":"10","author":"Bonadio","year":"1994","journal-title":"Pediatr Emerg Care"},{"key":"2021121010280453800_B20","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1016\/0022-3468(93)90691-D","article-title":"A safe and cost-effective protocol for the management of esophageal coins in children.","volume":"28","author":"Kelley","year":"1993","journal-title":"J Pediatr Surg"},{"key":"2021121010280453800_B21","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1001\/archpedi.1995.02170130038008","article-title":"Symptoms and spontaneous passage of esophageal coins.","volume":"149","author":"Conners","year":"1995","journal-title":"Arch Pediatr Adolesc Med"},{"key":"2021121010280453800_B22","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1097\/00006565-199704000-00017","article-title":"A literature-based comparison of three methods of pediatric esophageal coin removal.","volume":"13","author":"Conners","year":"1997","journal-title":"Pediatr Emerg Care"},{"key":"2021121010280453800_B23","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1001\/archpedi.1989.02150170044017","article-title":"Pediatric coin ingestion: a prospective study of coin location and symptoms.","volume":"143","author":"Schunk","year":"1989","journal-title":"Am J Dis Child"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/105\/1\/e5\/842256\/e5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/105\/1\/e5\/842256\/e5.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T05:36:59Z","timestamp":1682746619000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/105\/1\/e5\/65688\/Four-Strategies-for-the-Management-of-Esophageal"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,1,1]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2000,1,1]]},"published-print":{"date-parts":[[2000,1,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.105.1.e5","relation":{},"ISSN":["1098-4275","0031-4005"],"issn-type":[{"value":"1098-4275","type":"electronic"},{"value":"0031-4005","type":"print"}],"subject":[],"published":{"date-parts":[[2000,1,1]]}}}