Management of Asymptomatic Coin Ingestion

Abstract

Although the evidence-based management of pediatric coin ingestion has evolved over the past 20 years, several important questions remain. Among the most important of these questions is: Can previously healthy children who are asymptomatic after coin ingestion be safely managed with home observation, or should they have radiographs to rule out retained esophageal coins?1–3 Because a tremendous number of children swallow coins each year,4 many of whom are asymptomatic, this is an important public health question. The prospective comparison of immediate versus delayed endoscopic esophageal coin removal by Waltzman et al5 in this issue of Pediatrics provides important additional information toward answering this question. Their work is especially useful because it focuses on the clinical dilemma of the radiographically positive but asymptomatic child. In the past, hospital-based studies, typically retrospective case series, have suggested that although most children with coins lodged in the esophagus have suggestive signs or symptoms (eg, drooling, dysphagia, pain, foreign-body sensation), a substantial minority of children with esophageal coins are asymptomatic.1,6–7 Because unrecognized esophageal coins may lead to important, even life-threatening complications over time, these studies suggested that all children who swallow a coin, regardless … Address correspondence to Gregory P. Conners, MD, MPH, MBA, FAAP, Departments of Emergency Medicine and Pediatrics, University of Rochester Medical Center, 601 Elmwood Ave, Box 655, Rochester, NY 14642. E-mail: gregory_conners{at}urmc.rochester.edu