In Response to <i>pH‐Neutralizing Esophageal Irrigations as a Novel Mitigation Strategy for Button Battery Injury</i>

Anfang, Rachel R.; Jatana, Kris R.; Linn, Rebecca L.; Rhoades, Keith; Fry, Jared; Jacobs, Ian N.

doi:10.1002/lary.27546

Cited by 2 publications

(3 citation statements)

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“…Recent work demonstrated both in vitro and in vivo, using animal models that honey and sucralfate (Carafate) can be protective and help neutralize pH prior to BB removal. However, the 0.25% acetic acid irrigation intervention is intended for use in the operating room immediately after BB removal …”

Section: Discussionmentioning

confidence: 99%

“…However, the 0.25% acetic acid irrigation intervention is intended for use in the operating room immediately after BB removal. 15,16 This case series is the first to document multiple outcomes for the in vivo human application of intraoperative tissue pH neutralization after BB removal. There were no complications associated with the use of acetic acid irrigation in any of the patients, indicating that this may be a safe method to prevent progression of esophageal tissue injury.…”

Section: Discussionmentioning

confidence: 99%

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Initial clinical application of tissue pH neutralization after esophageal button battery removal in children

2019

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Objectives/Hypothesis Pediatric esophageal button battery (BB) injuries can progress even after removal and continue to be a significant source of morbidity and mortality. The objective in this case series is to present initial safety data for the human application of intraoperative tissue pH neutralization using 0.25% acetic acid irrigation after BB removal. Study Design Retrospective case series. Methods Pediatric patients who underwent rigid esophagoscopy for BB removal between October 2016 and December 2017 and who had the injury site irrigated with 120 to 150 mL sterile 0.25% acetic acid (pH = 3) were included in the study. Outcome measures included visual tissue appearance after irrigation, immediate or delayed esophageal perforation, and evidence of eventual esophageal stricture formation. Results Six pediatric patients (aged 19 months–10 years) had a 3 V lithium BB lodged in the esophagus for 2 to 18 hours and had irrigation of the esophageal injury site with sterile 0.25% acetic acid in the operating room after BB removal. None of the patients showed any evidence of thermal tissue injury. By surgeon assessment, all cases had improved visual esophageal tissue appearance. Neither immediate post‐operative or delayed onset esophageal perforation nor eventual stricture development were seen. Conclusions Esophageal irrigation in the operating room with sterile 0.25% acetic acid after BB removal, to neutralize the highly alkaline tissue microenvironment (pH 10–13) was safe and resulted in improved visual mucosal appearance. This immediate tissue pH neutralization may help halt the progression of liquefactive necrosis by immediately bringing tissue pH to physiologic range. This post‐removal irrigation technique is recommended by current National Capital Poison Center BB guidelines. Level of Evidence 4Laryngoscope, 129:1772–1776, 2019

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Initial clinical application of tissue pH neutralization after esophageal button battery removal in children

2019

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“…The authors state that the optimal time window for battery extraction is within 2 hours after ingestion; however, that 2‐hour threshold is arbitrary, as the tissue dissolution due to hyper‐hydroxic state at the battery's negative pole proceeds in a gradual fashion. We believe that the faster the battery is removed, the better (2). This speed is needed because even if the remaining electric charge of the battery is insufficient for domestic usage, the current is enough to inflict serious damage within the confines of the esophagus.…”

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confidence: 99%

Re: Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood

Dikkers

Ebels

2021

J. pediatr. gastroenterol. nutr.

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In Response to pH‐Neutralizing Esophageal Irrigations as a Novel Mitigation Strategy for Button Battery Injury

Cited by 2 publications

References 3 publications

Initial clinical application of tissue pH neutralization after esophageal button battery removal in children

Initial clinical application of tissue pH neutralization after esophageal button battery removal in children

Re: Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood

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