What goes in must come out

With bougienage, as the procedure is called, the goal is to push the coin down so it can then enter the digestive tract and be passed out in the natural course of events. Someone trained in the procedure can insert and withdraw the "bougie" in five seconds or less. No anaesthesia is necessary, other than perhaps an anaesthetic spray applied to the back of the child's throat.

In many cases, however, an endoscope is inserted into the throat in an effort to grasp the coin and pull it up, according to the report in the Annals of Emergency Medicine. Endoscopy in these circumstances is performed under general anaesthesia in the operating room.

To compare the safety and effectiveness of these procedures, a research team led by Dr. Joseph Leo Arms, from the Children's Hospitals and Clinics of Minnesota in Minneapolis, assessed the outcomes of 620 patients who were treated over a 12 year period at one of their emergency departments for a coin stuck in the oesophagus.

The average age of the patients was 3,7 years. Bougienage was used to manage 372 cases while 248 were treated with endoscopy.

Bougienage failed to do the trick for only 17 patients, all of whom were then successfully treated with endoscopy. Endoscopy was successful in all but one patient.

On average, the length of stay with endoscopy was 6,1 hours with an average hospital charge of $6 087 (about R48 000), whereas with bougienage, the stay was just 2,2 hours at a charge of $1 884 (about R15 000).

"Although several management options are available, in properly screened patients, bougienage is highly successful and safe and may provide significant savings of time and money," Arms' team concludes.