The mainstay of treatment of esophageal battery button impaction is emergency endoscopic removal, ideally within two hours of ingestion.⁸ Sucralfate or pasteurized honey, 10 mL every 10 minutes, should be given as soon as possible—within 12 hours of ingestion barring any airway concerns.⁸ Honey should be given no more than six times

and sucralfate no more than three times. These coat the battery and reduce pH to delay alkaline burns to the surrounding tissues but should not be considered a replacement for emergency surgical removal. An emergency department (ED) button battery pathway, including who to call for emergency endoscopic removal, transport to a tertiary care center if necessary, and location and dosing of first-line treatments, should be available in all EDs to help facilitate rapid and efficient diagnosis and management.

A controversial area in the management of button battery ingestions is in the asymptomatic patient with a battery discovered distal to the esophagus in the GI tract. Recent expert opinion-based guidelines from the Endoscopy Committee of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommended consideration of urgent endoscopic assessment and removal in patients older than five years or those in whom the battery is > 20 mm in diameter.⁸

The more we, as emergency physicians, understand about the recognition and management of button battery ingestions, the better equipped we are to educate the public about preventive measures such as counseling families with young children about how to safely use, store, and discard batteries, including taping over battery compartments and recycling used batteries. These are simple measures that can prevent this potentially catastrophic illness.

Many thanks to Dr. Olivia Ostrow for their expert contributions to the EM Cases podcast, which inspired this column.

Dr. Helman is an emergency physician at North York General Hospital in Toronto. He is an assistant professor at the University of Toronto, Division of Emergency Medicine, and the education innovation lead at the Schwartz/Reisman Emergency Medicine Institute. He is the founder and host of Emergency Medicine Cases podcast and website.

References

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3. National Capital Poison Center. Button Battery Ingestion Statistics. Accessed June 17, 2024.
4. Krom H, Visser M, Hulst JM, et al. Serious complications after button battery ingestion in children. Eur J Pediatr. 2018;177(7):1063-1070.
5. Soto PH, Reid NE, Litovitz TL. Time to perforation for button batteries lodged in the esophagus. Am J Emerg Med. 2019;37(5):805-809.
6. Baharudin N, Gendeh H, Teh HM. Neck radiograph halo sign: do not be fooled. Cureus. 2023;15(4):e38029.
7. Lorenzo C, Azevedo S, Lopes J, et al. Battery ingestion in children, an ongoing challenge: recent experience of a tertiary center. Front Pediatr. 2022;10:848092.
8. Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr. 2015;60(4):562–574.