Sa1547 Use of Endoscopic Ultrasound in Children As a Tool to Stratify High Risk Patients, After Button Battery Ingestions

Abstract

Injuries to children caused by batteries have been documented in the medical literature and by poison control centers for decades . Of particular concern is the ingestion of button batteries, especially those ≥20 mm in diameter (coin size), which can lodge in the esophagus, leading to serious complications or death. Most of the children are treated and released or examined and released without treatment; approximately 10% required hospitalization. However, serios injuries and death have been reported, usually associated with esophageal perforation, tracheo-esophageal fistula and exsanguination from aorto-esophageal fistula. Some complications may happen several days after ingestion and or removal of battery. In order to stratify high risk patients we evaluated the use of endoscopic ultrasound as a tool to identify these patients. We evaluated 13 patients with button battery ingestions between 2007-2011, ages (1-5 years old), at time of initial endoscopy and removal of foreign body an endoscopic ultrasound was preformed to evaluate; degree of supeficial burn, and distance from trachea and aorta. We then divided patients into 2 groups (low risk and high risk). Based on initial assesment paitents were closely monitored or discharged home. 4 patients (30%) were considered high risk, these were admmited for close follow up, 2 of these had chest MRI, due to concern for possible aorto-esophageal fistula. No mayor complications defined as perforation, tracheo o aorto esophageal fistula were seen. Endoscopic ultrasound can be a useful tool during the initial evaluation of children with potentialy serious foreign body ingestions, can possibly stratisfy high risk patients for close follow up, and decrease cost of performing unnecessary tests or admmisions on low risk patients.