Epidemiology and Management of Esophageal Coin Impaction in Children

Abstract

Purpose: The epidemiology of esophageal coin impaction (ECI) in children is poorly understood. Our aim was to assess characteristics of children presenting to a tertiary care center with ECI and identify predictors of type of coin impacted and management strategies. Methods: We conducted a retrospective study of the University of North Carolina (UNC) billing, clinical and endoscopy databases for all records with the ICD-9 code “935.1- foreign body in the esophagus” between January 2002 and December 2009. Charts were reviewed to identify cases of esophageal coin impaction. Pertinent data from first-time ECI cases were extracted. Descriptive statistics were used to summarize the findings, and bivariate analysis was performed to compare groups. Results: We identified 113 cases of ECI (55% male; 45% Caucasian; mean age 3 years, range 3 months-10 years). Coin ingestion was witnessed in 25 (28%) cases, and coins were most commonly ingested during the evening or nighttime hours. Pennies were the most commonly impacted coin (58% of cases), followed by quarters (16%) and dimes and nickels (9% each); 5% of cases had multiple coins impacted, and coin type was unspecified in 4%. Eighty-five (80%) cases involved an impaction located in the proximal esophagus, and 101 (89%) required a procedure. Thirty-five (34%) patients had an upper endoscopy performed by a gastroenterologist, and 68 (66%) had a laryngoscopy or esophagoscopy performed by an otolaryngologist. Coins were primarily extracted with forceps or coin graspers. Only two minor complications were noted (mucosal abrasion and bronchospasm). There was no significant relation between coin type, and patient race or gender, but quarters were more frequently impacted in older children (mean age 6 years) compared to the other coin types (p<0.001). We did not observe a significant relationship between coin type and location of impaction within the esophagus. However, cases performed by otolaryngologists were more likely to involve a proximally impacted coin (99%) than those performed by gastroenterologists (49%, p<0.001). Conclusion: Esophageal coin impaction disproportionately affected young children. While pennies were the most commonly impacted coin, there were no clear predictors of impaction based on coin type. Coin extraction was required in almost all cases, and while safe, this is an invasive and costly procedure. Physicians should emphasize the very real choking and swallowing risks associated with coins.