Tag Archives: foreign body

Proposed Treatment Algorithm for Water Bead Ingestions

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KH Denton et al. J Pediatr: Clin Pract 2026;22:200239. Pediatric Water Bead Ingestion: Experience from a Quaternary Care Children’s Hospital and a Proposed Management Algorithm

Methods: This retrospective chart review identified 36 pediatric patients (median age 2 yrs) who presented to a quaternary care children’s emergency department for water bead ingestion from 2015 to 2024.

Key findings:

  • The majority (n = 28, 78%) were asymptomatic.
  • Only 4 of 52 (8%) imaging studies were abnormal.
  • Endoscopy was performed in 6 (17%) patient encounters, none of which
    successfully retrieved water beads.
  • There were no patients with bowel obstructions or complications.

Discussion:

  • The results are “similar to a prior case series from 2011 to 2016, which examined 110 patients aged 19 years or younger who had called the Texas Poison Control Center for water bead ingestion. The study found that many were managed at home, without any known complications.”
  • “However, there are reports of morbidity and mortality associated with water bead ingestions. A literature review published in 2022 described 43 cases of bowel obstruction
    and 2 deaths following the ingestion of water beads.”
  • “Current NASPGHAN guidelines recommend early endoscopy in cases involving high-risk or potentially obstructive foreign bodies, with emphasis on emergent endoscopy in the case of superabsorbent objects such as water beads…Upon reviewing our data and the current
    literature, we propose a new algorithm for managing pediatric patients presenting with water bead ingestion.“
This “suggested algorithm remains provisional and informed by both experience and available literature to guide clinical decision-making but will require further validation before widespread adoption.”

My take: This article offers a practical approach to manage water bead ingestion and includes appropriate caution and caveats.

The recent ESPGHAN 2026 Position Paper (O Ledder et al. J Pediatr Gastroenterol Nutr. 2026;83:539–554) has not incorporated this suggested algorithm and is similar to previous NASPGHAN recommendations. See blog post on 9/28/26: “In cases of witnessed or suspected ingestion of SAP [superabsorbent polymers], emergency endoscopy should be performed to attempt retrieval of the material. If this is unsuccessful, or not completely retrieved, the child should be admitted for close observation with surgical support.”

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Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

ESPGHAN Position Paper: Management of Foreign Bodies (2026)

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O Ledder et al. J Pediatr Gastroenterol Nutr. 2026;83:539–554. Open Access! Foreign body ingestions in children and adolescents: A position paper of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) endoscopy special interest group

In 2015, NASPGHAN’s endoscopy committee published a report on the management of foreign bodies (see: Foreign Bodies in Children -Expert Guidance). This was quite helpful. This ESPGHAN position paper provides updated guidance though many of the recommendations are unchanged.

Overall Treatment Algorithm:

Button Batteries

Blunt Objects/Benign Foreign Bodies

  • Superabsorbent polymers (SAP) Since these items are translucent, imaging is useful only for identifying the sequelae of the ingestion, but not the SAP itself… In cases of witnessed or suspected ingestion of SAP, emergency endoscopy should be performed to attempt retrieval of the material. If this is unsuccessful, or not completely retrieved, the child should be admitted for close observation with surgical support.

Magnets:

  • On table fluoroscopy has been suggested to confirm removal of all magnets if there is doubt whether all have been retrieved. (My personal experience is that fluoroscopy is particularly helpful if a colonoscopy is needed.)

Sharp Objects

My take: These guidelines are similar the previous NASPGHAN endoscopy committee recommendations from 2015. They are still worth a read for more context and there are a lot of endoscopy pointers in this report.

Related blog posts:

Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

An Esophageal Coin with Moth Eaten Appearance

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M Hook et al. JPGN 2025; DOI: 10.1002/jpn3.70221. Esophageal coin with moth eaten appearance: A cause for caution

This case report describes a penny ingestion by a 10 yo with autism that likely happened nine months before attempted retrieval. The coin was not able to be retrieved due to stricturing but was advanced into the stomach (the authors note advancement into duodenum would be better); in addition, there was an esophageal diverticulum that was identified likely secondary to the caustic damage.

In the discussion, the authors note that “the ‘moth eaten’ appearance is a rare finding that indicates prolonged foreign body retention and unforeseen mucosal injury…It is specific to post-1982 pennies, composed of 97.5% zinc.4 Hydrochloric acid exposure dissolves zinc, forming caustic zinc chloride.”

My take: Future generations will not see this radiologic finding. For now, if this finding is seen, it likely indicates a more difficult foreign body removal.

Related blog posts:

Ref: https://www.pbs.org/newshour/nation/u-s-mint-in-philadelphia-to-press-final-penny-as-the-1-cent-coin-gets-canceled

How Often Esophageal Coins Pass Into the Stomach

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P Quitadomo et al. Am J Gastroenterol 2025; 120: 1388-1390. “Insert-Coin”: A Prospective Study of Coin Ingestion in Children of Southern Italy

Thanks to Ben Gold for this reference.

This prospective study from Naples, Italy examined children 0-14 yrs of age with a coin ingestion (n=807). Children with coins in the proximal esophagus underwent endoscopic removal within 4 hours whereas those with middle to lower esophageal coins had re-evaluation after 12 hours before removal.

Key findings:

  • 52 of 807 (6.4%) had a coin retained in the esophagus, the remainder were in the stomach or beyond
  • 20 of 52 (38%) were located in the middle to lower esophagus (10 in each)
  • 13 of 20 (65%) coins in the middle to lower esophagus had spontaneous gastric passage
  • The mean age of patients with gastric passage (72 months) was higher than those without passage (48 months)

My take: Only 6% of patients in this study who had a coin ingestion had esophageal retention of the coin. In addition, one-fourth of those with esophageal coins had spontaneous passage into the stomach. This occurred only with the mid-distal esophageal coins; in this subset it occurred in 65%. Thus, in those with mid-distal esophageal coins, watchful waiting for ~12 hrs may be beneficial for patients. The ultimate primary prevention of this problem may occur with more widespread adoption of electronic payments.

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Agnes Northrup of Louis Tiffany Studio,
Tiffany Garden Landscape Window (1912)
at The Metropolitan Museum of Art
Agnes Northrup of Louis Tiffany Studio,
Autumn Landscape  (1923) at The Metropolitan Museum of Art

Sharp Objects in GI Tract & Good Outcomes

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P Quitadamo et al. JPGN 2023; 76: 213-217. Sharp-Pointed Foreign Body Ingestion in Pediatric Age

In this study with 580 children, consecutively recruited from 2016 to 2020, the authors examined outcomes after ingestion of sharp-pointed foreign bodies (FBs).

Key findings:

  • Mean age was 50 months.
  • Sharp/pointed FBs mainly included fragments of metal 270 of 580 (46.55%) and glass 180 of 580 (31%).
  • FBs were endoscopically removed in 79 of 580 (13.6%) children whereas the remaining FBs passed through the gastrointestinal tract over an overall mean time of 29 hours
  • No cases of intestinal perforation nor prolonged retention were observed.
  • The most common metal objects were earrings (n=72). Other objects: screws (n=20), dental works (n=20), nails (n=13), open safety pins (n=7), fish bones (n=65)

My take: I have not had a severe complication from sharp-pointed FBs (in nearly 30 yrs of pediatric GI practice); this article confirms the overall low risk that they pose.

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Turtle at Chattahoochee Nature Center

Selected Slides from NASPGHAN 2022 Postgraduate Course (Part 1)

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Pediatric Foreign Body Ingestions
Esophageal Strictures
Esophageal Strictures
Imaging for Acute Pancreatitis
Imaging for Acute Pancreatitis
For Acute Liver Failure
For Acute Liver Failure
For Acute Liver Failure

Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician.  Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

Orbeez Ball Obstruction

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Z Patel et al. Gastroenterol 2021: 161. https://doi.org/10.1053/j.gastro.2020.10.051. Full text: An Unusual Case of Small Bowel Obstruction

Case report of a 10 month old who developed a small bowel obstruction due to an “Orbeez” ball. “Orbeez balls are small polymer beads that absorbs water and expands, it can get up to 150 times their original size. When left out of water, the beads shrink back down to its original size. They were originally invented as a way to keep moisture in soil for plants. They are hugely popular with children and often used as toys, flower holders, air fresheners, light jars, and objets d’art in the house.”

Related blog post: Foreign Bodies in Children –Expert Guidance

#NASPGHAN19 Postgraduate Course (Part 1)

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Here are some selected slides and notes from this year’s NASPGHAN’s postrgraduate course.  My notes from these lectures may contain errors in omission or transcription.

Link to the full NASPGHAN PG Syllabus 2019

8:00 – 9:00 Module 1 – Endoscopy

11  David Brumbaugh, MD, Children’s Hospital Colorado  Management of foreign bodies

Related blog posts:

22 Petar Mamula, MD, Children’s Hospital of Philadelphia Advanced endoscopic techniques for gastrointestinal bleeding

This talk had some terrific videos (not available in syllabus) and useful practical points.  For example, with cautery, the speaker recommended not just quickly taping the lesion, count for several seconds when applying.  For hemospray, the speaker considers this technically much easier but is using this mainly as a backup option.

Here are two screenshots (not from lecture) which provide information from manufacturer on Hemospray use (link to PDF on Hemospray Manufacturer’s PDF on Hemospray)

Related blog posts:

36 Srinadh Komanduri, MD, Northwestern Medicine  Cancer screening top to bottom

Some of the key points:

  • IBD and colorectal cancer (CRC) screening 8-10 years after disease onset
  • ~10% of CRC in general population occurs between 20-49 years
  • Chromoendoscopy results in higher detection rates of dysplasia

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Disclaimer: NASPGHAN/gutsandgrowth assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. The discussion, views, and recommendations as to medical procedures, choice of drugs and drug dosages herein are the sole responsibility of the authors. Because of rapid advances in the medical sciences, the Society cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. Some of the slides reproduced in this syllabus contain animation in the power point version. This cannot be seen in the printed version.