1 in 4 Pass Without Intervention

Esophageal obstruction due to foreign body ingestion is a common clinical emergency and a frequent reason for emergency room visits in both adults and children, with more than 150,000 cases reported annually in the United States alone. Obstruction typically occurs at one of three physiological narrowing points in the esophagus: the cricopharyngeal muscle, the level of the aortic arch or left main bronchus, and the diaphragmatic esophageal hiatus.

Although 80%-90% of foreign body ingestions are asymptomatic and do not require endoscopic removal, certain objects — such as button batteries or sharp items — and specific anatomical locations present a higher risk for complications.

Among children, coins are the most commonly ingested foreign objects. They generally cause little or no damage to the mucosa and are often passed spontaneously through the gastrointestinal tract without intervention.

However, if a coin becomes lodged in the esophagus, endoscopic removal is typically required to alleviate symptoms and prevent the risk for airway obstruction due to aspiration. When a coin is retained in the distal esophagus, there is no clear consensus on the timing of intervention, as 25%-30% of such cases may resolve spontaneously as the coin passes into the stomach. Still, data on the rate of spontaneous gastric migration remain limited.

Ingestion in Children

A prospective study examined a large cohort of children treated for coin ingestion at a pediatric hospital in southern Italy, a regional referral center for emergency endoscopy. The objective was to assess the need for endoscopic removal, the likelihood of spontaneous gastric passage, and any associated complications.

Between 2017 and 2022, 3168 children were hospitalized for foreign body ingestion. Of these, 807 (25.5%) had ingested a coin.

• In 52 of the 807 children (6.4%), the coin was retained in the esophagus.
• In the remaining 755 children (93.6%), the coin had progressed to the stomach or beyond.

Of the 52 esophageal cases:

• 32 (61.5%) involved the proximal esophagus
• 10 (19.2%) the mid esophagus
• 10 (19.2%) the distal esophagus 

Spontaneous passage into the stomach occurred in 13 of 20 children (65%) with mid or distal esophageal retention. In the remaining 7 of 12 children (35%), the coin remained lodged and required endoscopic removal.

All endoscopic procedures were performed under general anesthesia, and all coins were successfully retrieved. No esophageal mucosal injuries or anesthesia-related adverse events were reported.

Clinical Takeaways

• The study confirms that coin ingestion accounts for a high proportion (25.5%) of all pediatric foreign body ingestion cases.
• In most cases (93.6%), ingested coins passed through the gastrointestinal tract without becoming lodged in the esophagus or requiring intervention.
• About one quarter of esophageal coin cases resolved spontaneously within hours, particularly those located in the mid or distal esophagus. Specifically, 65% of these cases saw the coin pass into the stomach without requiring removal.
• When a coin is lodged in the mid or distal esophagus, the study supports a watchful waiting approach for at least 6-12 hours — especially in older children — as two thirds of these cases may resolve without endoscopic intervention.

This story was translated from Univadis Italy.