Many years ago I noticed the tremendous burden that coin ingestions cause in terms of ER visits and need for endoscopy/anesthesia. As a result, I contacted the US treasury. I think if any other product resulted in this many hospitalizations and endoscopic procedures it would be removed from the market. Well, the treasury stated that the coins are mandated by Congress and any change would need to be initiated in Congress. So, I contacted our Georgia senator and informed the office about the problem. Apparently, it could be a while before this becomes a priority for him.
Some good news, though, based on a recent article, watchful waiting may be appropriate for many esophageal coins (Emerg Med J 2012; doi: 10.1136/emermed-2011-200958). (The blog title quote comes from Bill Balistreri who use to say that it was not worth it to take out anything less than a quarter —just watch for change in the stools.)
Acheson J et al performed a retrospective review of esophageal coin ingestions between 2004-2010 (age <16 years). Among asymptomatic patients who were told to wait 18 hours for a repeat xray, 33 of 37 passed spontaneously.
- Previous esophageal disease
- Previous tracheal disease
- Coins present >24 hours
All mid-to-lower coins (that were given 18 hours) passed in this study. The authors note that previous studies had spontaneous passage rates of 30-60%. Some of the difference may be related to differences in the UK coins compared to coins in US. In the UK, the authors suggest that patients who are asymptomatic and with no other risk factors should be sent home and reevaluated the next day.
**Before sending them home, make sure the “coin” is not really a button battery by examining the radiograph carefully.
- -Pediatrics 2005; 116: 752 (editorial), 614-19 (article). 25-30% of coins (esp distal -56%) will pass spontaneously if given time (8-16hrs)–in this randomized study.
- -Arch Pediatr Adol Med 1999; 153: 1073. 28% of uncomplicated esophageal coins pass c/in 24hrs
- Emerg Med J doi:10.1136/emermed-2011-200958
[Link to free full-text EMJ article]