Mistakes in paediatric foreign body ingestion and how to avoid them

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Mistakes in paediatric foreign body ingestion and how to avoid them

Raoul I. Furlano, Lissy de Ridder, Jorge Amil Dias, Christos Tzivinikos

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Ikenberry SO, Jue TL, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, et al. Management of ingested foreign bodies and food impactions. Gastrointes Endosc 2011; 73 (6): 1085–1091.

Cheng W, Tam PKH. Foreign-body ingestion in children: Experience with 1,265 cases. J Pediatr Surg 1999; 34 (10): 1472–1476.

Labadie M, O’Mahony E, Capaldo L, Courtois A, Lamireau T, Nisse P, et al. Severity of button batteries ingestions: data from French Poison Control Centres between 1999 and 2015. Eur J Emerg Med 2018; 25 (4): e1–8.

Gerner P, Pallacks F, Laschat M, Hermanns-Clausen M. Health damages after ingestion of button batteries in childhood. Bundesgesundheitsblatt Gesundheits-forschung Gesundheitsschutz 2019; 62 (11):1354–1361.

Jiraki K. Aortoesophageal Conduit Due to a Foreign Body. Am J Forensic Med Pathol 1996; 17 (4): 347.

Guelfguat M, Kaplinskiy V, Reddy SH, DiPoce J. Clinical Guidelines for Imaging and Reporting Ingested Foreign Bodies. Am J Roentgenol 2014; 203 (1): 37–53.

Tseng HJ, Hanna TN, Shuaib W, Aized M, Khosa F, Linnau KF. Imaging Foreign Bodies: Ingested, Aspirated, and Inserted. Ann Emerg Med 2015; 66 (6): 570-582.e5.

Thomson M, Tringali A, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, et al. Paediatric Gastrointestinal Endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy Guidelines. J Pediatr Gastroenterol Nutr 2017; 64 (1): 133.

Donnelly LF, Frush DP, Frush KS. Aspirated contrast material contributing to respiratory arrest in a pediatric trauma patient. Am J Roentg 1998; 171 (2): 471–473.

10.

Schalamon J, Haxhija EQ, Ainoedhofer H, Gössler A, Schleef J. The use of a hand-held metal detector for localisation of ingested metallic foreign bodies - a critical investigation. Eur J Pediatr 2004; 163 (4–5): 257–259.

11.

Spina P, Minniti S, Bragheri R. Usefulness of ultrasonography in gastric foreign body retention. Pediatr Radiol 2000; 30 (12): 840–841.

12.

Hissa M, Al-Edreesi M, Abdi R. Sonographic diagnosis of gastric-outlet foreign body: case report and review of literature. J Family Community Med 2009; 16 (1): 33–36.

13.

Ingraham CR, Mannelli L, Robinson JD, Linnau KF. Radiology of foreign bodies: how do we image them? Emerg Radiol 2015; (4): 425–430.

14.

Spiers A, Jamil S, Whan E, Forbes D, Gollow I, Andrews D. Survival of patient after aorto-oesophageal fistula following button battery ingestion. ANZ J Surgery 2012; 82 (3): 186–187.

15.

Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging battery-ingestion hazard: clinical implications. Pediatrics 2010; 125 (6): 1168–1177.

16.

Wright K, Parkins K, Jahn H, Rowlands R, Davies F. Catastrophic haemorrhage from BB ingestion in children: a growing problem. Acta Paediatr 2017;106 (9): 1391-1393.

17.

Heckstall RL, Hollander JE. Aortoesophageal Fistula: Recognition and Diagnosis in the Emergency Department. Ann Emerg Med 1998; 32 (4): 502–505.

18.

Brumbaugh DE, Colson SB, Sandoval JA, Karrer FM, Bealer JF, Litovitz T, et al. Management of Button Battery–induced Hemorrhage in Children. J Pediatr Gastroenterol Nutr 2011; 52 (5): 585.

19.

Jatana KR, Litovitz T, Reilly JS, Koltai PJ, Rider G, Jacobs IN. Pediatric button battery injuries: 2013 task force update. Int J Pediatr Otorhinolaryngol 2013; 77 (9): 1392–1399.

20.

Whelan R, Shaffer A, Dohar JE. Button battery versus stacked coin ingestion: A conundrum for radiographic diagnosis. Int J Pediatr Otorhinolaryngol 2019; 126: 109627.

21.

Lerner DG, Brumbaugh D, Lightdale JR, Jatana KR, Jacobs IN, Mamula P. Mitigating Risks of Swallowed Button Batteries: New Strategies Before and After Removal. J Pediatr Gastroenterol Nutr 2020; 70 (5): 542-546.

22.

Sethia R, Gibbs H, Jacobs IN, Reilly JS, Rhoades K, Jatana KR. Current management of BB injuries. Laryngoscope Investig Otolaryngol 2021; 6 (3): 549-563.

23.

Anfang RR, Jatana KR, Linn RL, Rhoades K, Fry J, Jacobs IN. pH-neutralizing esophageal irrigations as a novel mitigation strategy for BB injury. Laryngoscope 2019; 129 (1): 49-57.

24.

Mubarak A, Benninga MA, Broekaert I, Dolinsek J, Homan M, Mas E. Diagnosis, Management, and Prevention of BB Ingestion in Childhood: A European Society for Paediatric Gastroenterology Hepatology and Nutrition Position Paper. J Pediatr Gastroenterol Nutr 2021; 73 (1):129-136.

25.

Leinwand K, Brumbaugh DE, Kramer RE. BB Ingestion in Children: A Paradigm for Management of Severe Pediatric Foreign Body Ingestions. Gastrointest Endosc Clin N Am 2016; 26 (1): 99-118.

26.

Bendig DW, Mackie GG. Management of Smooth-Blunt Gastric Foreign Bodies in Asymptomatic Patients. Clin Pediatr (Phila) 1990; 29 (11): 642–645.

27.

Farmakakis T, Dessypris N, Alexe DM, Frangakis C, Petoussis G, Malliori M, et al. Magnitude and object-specific hazards of aspiration and ingestion injuries among children in Greece. Int J Pediatr Otorhinolaryngol 2007;7 (2): 317–324.

28.

Seng Loh K, Siang Tan LK, Smith JD, Hian Yeoh K, Dong F. Complications of Foreign Bodies in the Esophagus. Otolaryngol Head Neck Surg 2000;123 (5): 613–616.

29.

Park JH, Park CH, Park JH, Lee SJ, Lee WS, Joo YE, et al. Review of 209 cases of foreign bodies in the upper gastrointestinal tract and clinical factors for successful endoscopic removal. Korean J Gastroenterol 2004; 43 (4): 226–233.

30.

Laserna-Mendietaa E J, Navarroa P, Casabona-Francés S, Savarino EV, Pérez-Martínez I, Guagnozzi D. Differences between childhood- and adulthood-onset eosinophilic esophagitis: An analysis from the EoE connect registry. Digestive Liver Dis 2023; 55 (3): 350-359.

31.

Hachimi-Idrissi S, Corne L, Vandenplas Y. Management of ingested foreign bodies in childhood: our experience and review of the literature. Eur J Emerg Med 1998; 5 (3): 319–324.

32.

Panieri E, Bass DH. The management of ingested foreign bodies in children - a review of 663 cases. Eur J Emerg Med 1995;2 (2):83–87.

33.

Lee JH. Foreign Body Ingestion in Children. Clin Endosc 2018; 51 (2): 129-136.

34.

Kramer RE, Lerner DG, Lin T, Manfredi M, Shah M, Stephen TC, 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.

35.

Braumann C, Goette O, Menenakos C, Ordemann J, Jacobi CA. Laparoscopic removal of ingested pin penetrating the gastric wall in an immunosuppressed patient. Surg Endosc 2004;18 (5): 870–870.

36.

Mehran A, Podkameni D, Rosenthal R, Szomstein S. Gastric Perforation Secondary to Ingestion of a Sharp Foreign Body. JSLS 2005; 9(1): 91–93.

37.

Goh BKP, Chow PKH, Quah HM, Ong HS, Eu KW, Ooi LLPJ, et al. Perforation of the Gastrointestinal Tract Secondary to Ingestion of Foreign Bodies. World J Surg 2006; 30 (3): 372–377.

38.

Akçam M, Koçkar C, Tola HT, Duman L, Gündüz M. Endoscopic removal of an ingested pin migrated into the liver and affixed by its head to the duodenum. Gastrointest Endosc 2009; 69 (2): 382–384.

39.

Garcia-Segui A, Bercowsky E, Gómez-Fernández I, Gibernau R, Gascón Mir M. Late migration of a toothpick into the bladder: initial presentation with urosepsis and hydronephrosis. Arch Esp Urol 2012; 65 (6): 626–629.

40.

.Karadayı Ş, Şahin E, Nadir A, Kaptanoğlu M. Wandering pins: case report. Cumhuriyet Med J 2009; 31: 300-302

41.

Prasad TS, Low Y, Tan C, Jacobsen A. Swallowed Foreign Bodies in Children: Report of Four Unusual Cases. Ann Acad Med Singap 2006; 35 (1): 49–53.

42.

Madrona AP, Hernández JAF, Prats MC, Riquelme JR, Paricio PP. Intestinal Perforation by Foreign Bodies. Eur J Surg 2000;166 (4): 307–309.

43.

Palta R, Sahota A, Bemarki A, Salama P, Simpson N, Laine L. Foreign-body ingestion: characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion. Gastrointest Endosc 2009; 69 (3, Part 1): 426–433.

44.

Hameed K, Hassan MK, Rehman S, Khan D, Khan IM, Khattak AK. Management of foreign bodies in the upper gastrointestinal tract with flexible endoscope. J Postgrad Med Inst 2011; 25 (1).

45.

Tokar B, Cevik AA, Ilhan H. Ingested gastrointestinal foreign bodies: predisposing factors for complications in children having surgical or endoscopic removal. Pediatr Surg Int 2007; 23(2):135–139.

46.

Gregori D, Scarinzi C, Morra B, Salerni L, Berchialla P, Snidero S, et al. Ingested foreign bodies causing complications and requiring hospitalization in European children: Results from the ESFBI study. Pediatr Int 2010; 52 (1): 26–32.

47.

Paul RI, Christoffel KK, Binns HJ, Jaffe DM, The Pediatric Practice Research Group. Foreign Body Ingestions in Children: Risk of Complication Varies With Site of Initial Health Care Contact. Pediatrics 1993; 91 (1):121–127.

48.

Rodríguez-Hermosa JI, Codina-Cazador A, Sirvent JM, Martín A, Gironès J, Garsot E. Surgically treated perforations of the gastrointestinal tract caused by ingested foreign bodies. Colorectal Dis 2008; 10 (7): 701–707.

49.

Nugud AA, Tzivinikos C, Assa A, Borrelli O, Broekaert I, Martin-de-Carpi J, et al. Pediatric Magnet Ingestion, Diagnosis, Management, and Prevention: A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Position Paper. J Pediatr Gastroenterol Nutr 2023; 76 (4): 523–32.

50.

Lancashire MJR, Legg PK, Lowe M, Davidson SM, Ellis BW. Surgical aspects of international drug smuggling. Br Med J (Clin Res Ed). 1988; 296 (6628): 1035–1037.

51.

Beno S, Calello D, Baluffi A, Henretig FM. Pediatric Body Packing: Drug Smuggling Reaches a New Low. Pediatr Emerg Care 2005; 21 (11): 744–746.

52.

Popel J, El-Hakim H, El-Matary W. Esophageal foreign body extraction in children: flexible versus rigid endoscopy. Surg Endosc 2011; 25 (3): 919–922.

53.

Berggreen PJ, Edwyn Harrison M, Sanowski RA, Ingebo K, Noland B, Zierer S. Techniques and complications of esophageal foreign body extraction in children and adults. Gastrointest Endosc 1993; 39 (5): 626–630.

54.

Sethia R, Gibbs H, Jacobs IN, Reilly JS, Rhoades K, Jatana KR. Current management of button battery injuries. Laryngosc Investig Otolaryngol 2021; 6 (3): 549–563.

55.

Mubarak A, Benninga MA, Broekaert I, Dolinsek J, Homan M, Mas E, et al. Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood: A European Society for Paediatric Gastroenterology Hepatology and Nutrition Position Paper. J Pediatr Gastroenterol Nutr 2021; 73 (1): 129–136.

56.

Kodituwakku R, Palmer S, Paul SP. Management of foreign body ingestions in children: button batteries and magnets. Br J Nurs Mark Allen Publ 2017; 27; 26 (8): 456–461.

57.

Caré W, Dufayet L, Paret N, Manel J, Laborde-Casterot H, Blanc-Brisset I, et al. Bowel obstruction following ingestion of superabsorbent polymers beads: literature review. Clin Toxicol 2022; 60 (2):159–167.

Abstract

Foreign bodies swallowed by children can pose serious health risks if not handled properly. This article sheds light on common mistakes made during such emergencies and provides guidance on how to avoid them. In just a 15-minute read, you can be better prepared to address this critical situation.

Topics

Primary Care

Citation

Furlano RI, Amil-Dias J, De Ridder L and Tzivinikos C. Mistakes in paediatric foreign body ingestion and how to avoid them. UEG Education 2024; 24: 1-7.

Published

2024

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Ikenberry SO, Jue TL, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, et al. Management of ingested foreign bodies and food impactions. Gastrointes Endosc 2011; 73 (6): 1085–1091.

Cheng W, Tam PKH. Foreign-body ingestion in children: Experience with 1,265 cases. J Pediatr Surg 1999; 34 (10): 1472–1476.

Jiraki K. Aortoesophageal Conduit Due to a Foreign Body. Am J Forensic Med Pathol 1996; 17 (4): 347.

Guelfguat M, Kaplinskiy V, Reddy SH, DiPoce J. Clinical Guidelines for Imaging and Reporting Ingested Foreign Bodies. Am J Roentgenol 2014; 203 (1): 37–53.

Tseng HJ, Hanna TN, Shuaib W, Aized M, Khosa F, Linnau KF. Imaging Foreign Bodies: Ingested, Aspirated, and Inserted. Ann Emerg Med 2015; 66 (6): 570-582.e5.

Donnelly LF, Frush DP, Frush KS. Aspirated contrast material contributing to respiratory arrest in a pediatric trauma patient. Am J Roentg 1998; 171 (2): 471–473.

10.

11.

Spina P, Minniti S, Bragheri R. Usefulness of ultrasonography in gastric foreign body retention. Pediatr Radiol 2000; 30 (12): 840–841.

12.

Hissa M, Al-Edreesi M, Abdi R. Sonographic diagnosis of gastric-outlet foreign body: case report and review of literature. J Family Community Med 2009; 16 (1): 33–36.

13.

Ingraham CR, Mannelli L, Robinson JD, Linnau KF. Radiology of foreign bodies: how do we image them? Emerg Radiol 2015; (4): 425–430.

14.

Spiers A, Jamil S, Whan E, Forbes D, Gollow I, Andrews D. Survival of patient after aorto-oesophageal fistula following button battery ingestion. ANZ J Surgery 2012; 82 (3): 186–187.

15.

Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging battery-ingestion hazard: clinical implications. Pediatrics 2010; 125 (6): 1168–1177.

16.

Wright K, Parkins K, Jahn H, Rowlands R, Davies F. Catastrophic haemorrhage from BB ingestion in children: a growing problem. Acta Paediatr 2017;106 (9): 1391-1393.

17.

Heckstall RL, Hollander JE. Aortoesophageal Fistula: Recognition and Diagnosis in the Emergency Department. Ann Emerg Med 1998; 32 (4): 502–505.

18.

Brumbaugh DE, Colson SB, Sandoval JA, Karrer FM, Bealer JF, Litovitz T, et al. Management of Button Battery–induced Hemorrhage in Children. J Pediatr Gastroenterol Nutr 2011; 52 (5): 585.

19.

Jatana KR, Litovitz T, Reilly JS, Koltai PJ, Rider G, Jacobs IN. Pediatric button battery injuries: 2013 task force update. Int J Pediatr Otorhinolaryngol 2013; 77 (9): 1392–1399.

20.

Whelan R, Shaffer A, Dohar JE. Button battery versus stacked coin ingestion: A conundrum for radiographic diagnosis. Int J Pediatr Otorhinolaryngol 2019; 126: 109627.

21.

22.

Sethia R, Gibbs H, Jacobs IN, Reilly JS, Rhoades K, Jatana KR. Current management of BB injuries. Laryngoscope Investig Otolaryngol 2021; 6 (3): 549-563.

23.

Anfang RR, Jatana KR, Linn RL, Rhoades K, Fry J, Jacobs IN. pH-neutralizing esophageal irrigations as a novel mitigation strategy for BB injury. Laryngoscope 2019; 129 (1): 49-57.

24.

25.

Leinwand K, Brumbaugh DE, Kramer RE. BB Ingestion in Children: A Paradigm for Management of Severe Pediatric Foreign Body Ingestions. Gastrointest Endosc Clin N Am 2016; 26 (1): 99-118.

26.

Bendig DW, Mackie GG. Management of Smooth-Blunt Gastric Foreign Bodies in Asymptomatic Patients. Clin Pediatr (Phila) 1990; 29 (11): 642–645.

27.

28.

Seng Loh K, Siang Tan LK, Smith JD, Hian Yeoh K, Dong F. Complications of Foreign Bodies in the Esophagus. Otolaryngol Head Neck Surg 2000;123 (5): 613–616.

29.

30.

31.

Hachimi-Idrissi S, Corne L, Vandenplas Y. Management of ingested foreign bodies in childhood: our experience and review of the literature. Eur J Emerg Med 1998; 5 (3): 319–324.

32.

Panieri E, Bass DH. The management of ingested foreign bodies in children - a review of 663 cases. Eur J Emerg Med 1995;2 (2):83–87.

33.

Lee JH. Foreign Body Ingestion in Children. Clin Endosc 2018; 51 (2): 129-136.

34.

35.

Braumann C, Goette O, Menenakos C, Ordemann J, Jacobi CA. Laparoscopic removal of ingested pin penetrating the gastric wall in an immunosuppressed patient. Surg Endosc 2004;18 (5): 870–870.

36.

Mehran A, Podkameni D, Rosenthal R, Szomstein S. Gastric Perforation Secondary to Ingestion of a Sharp Foreign Body. JSLS 2005; 9(1): 91–93.

37.

Goh BKP, Chow PKH, Quah HM, Ong HS, Eu KW, Ooi LLPJ, et al. Perforation of the Gastrointestinal Tract Secondary to Ingestion of Foreign Bodies. World J Surg 2006; 30 (3): 372–377.

38.

Akçam M, Koçkar C, Tola HT, Duman L, Gündüz M. Endoscopic removal of an ingested pin migrated into the liver and affixed by its head to the duodenum. Gastrointest Endosc 2009; 69 (2): 382–384.

39.

40.

.Karadayı Ş, Şahin E, Nadir A, Kaptanoğlu M. Wandering pins: case report. Cumhuriyet Med J 2009; 31: 300-302

41.

Prasad TS, Low Y, Tan C, Jacobsen A. Swallowed Foreign Bodies in Children: Report of Four Unusual Cases. Ann Acad Med Singap 2006; 35 (1): 49–53.

42.

Madrona AP, Hernández JAF, Prats MC, Riquelme JR, Paricio PP. Intestinal Perforation by Foreign Bodies. Eur J Surg 2000;166 (4): 307–309.

43.

44.

Hameed K, Hassan MK, Rehman S, Khan D, Khan IM, Khattak AK. Management of foreign bodies in the upper gastrointestinal tract with flexible endoscope. J Postgrad Med Inst 2011; 25 (1).

45.

Tokar B, Cevik AA, Ilhan H. Ingested gastrointestinal foreign bodies: predisposing factors for complications in children having surgical or endoscopic removal. Pediatr Surg Int 2007; 23(2):135–139.

46.

47.

48.

49.

50.

Lancashire MJR, Legg PK, Lowe M, Davidson SM, Ellis BW. Surgical aspects of international drug smuggling. Br Med J (Clin Res Ed). 1988; 296 (6628): 1035–1037.

51.

Beno S, Calello D, Baluffi A, Henretig FM. Pediatric Body Packing: Drug Smuggling Reaches a New Low. Pediatr Emerg Care 2005; 21 (11): 744–746.

52.

Popel J, El-Hakim H, El-Matary W. Esophageal foreign body extraction in children: flexible versus rigid endoscopy. Surg Endosc 2011; 25 (3): 919–922.

53.

54.

Sethia R, Gibbs H, Jacobs IN, Reilly JS, Rhoades K, Jatana KR. Current management of button battery injuries. Laryngosc Investig Otolaryngol 2021; 6 (3): 549–563.

55.

56.

Kodituwakku R, Palmer S, Paul SP. Management of foreign body ingestions in children: button batteries and magnets. Br J Nurs Mark Allen Publ 2017; 27; 26 (8): 456–461.

57.

Abstract

Dysphagia is a common symptom with a broad differential diagnosis encompassing structural, inflammatory, infectious, functional, neurological, and oesophageal motility disorders. Despite major advances in endoscopy, high-resolution manometry (HRM), impedance planimetry (EndoFLIP), and swallowing assessment, diagnostic delays and inappropriate management remain common. In most cases, these shortcomings reflect errors in clinical reasoning rather than limitations of available investigations.¹

Increasing recognition of eosinophilic oesophagitis (EoE), functional dysphagia, opioid-induced oesophageal dysfunction, and complex motility disorders has further emphasised the importance of integrating clinical history with endoscopic, histological, physiological, and complementary radiological findings. Optimal evaluation increasingly requires multidisciplinary collaboration involving gastroenterologists, otolaryngologists, neurologists, speech–language pathologists, radiologists, and surgeons.¹^–⁵

In this article, we discuss the most common mistakes in the evaluation and management of dysphagia and provide practical, evidence-based recommendations to help clinicians avoid them.

Topics

Neurogastroenterology & Motility

Published

2026

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Spyridon Pantzios, Ioannis Elefsiniotis, Christos Triantos

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Ikenberry SO, Jue TL, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, et al. Management of ingested foreign bodies and food impactions. Gastrointes Endosc 2011; 73 (6): 1085–1091.

Cheng W, Tam PKH. Foreign-body ingestion in children: Experience with 1,265 cases. J Pediatr Surg 1999; 34 (10): 1472–1476.

Jiraki K. Aortoesophageal Conduit Due to a Foreign Body. Am J Forensic Med Pathol 1996; 17 (4): 347.

Guelfguat M, Kaplinskiy V, Reddy SH, DiPoce J. Clinical Guidelines for Imaging and Reporting Ingested Foreign Bodies. Am J Roentgenol 2014; 203 (1): 37–53.

Tseng HJ, Hanna TN, Shuaib W, Aized M, Khosa F, Linnau KF. Imaging Foreign Bodies: Ingested, Aspirated, and Inserted. Ann Emerg Med 2015; 66 (6): 570-582.e5.

Donnelly LF, Frush DP, Frush KS. Aspirated contrast material contributing to respiratory arrest in a pediatric trauma patient. Am J Roentg 1998; 171 (2): 471–473.

10.

11.

Spina P, Minniti S, Bragheri R. Usefulness of ultrasonography in gastric foreign body retention. Pediatr Radiol 2000; 30 (12): 840–841.

12.

Hissa M, Al-Edreesi M, Abdi R. Sonographic diagnosis of gastric-outlet foreign body: case report and review of literature. J Family Community Med 2009; 16 (1): 33–36.

13.

Ingraham CR, Mannelli L, Robinson JD, Linnau KF. Radiology of foreign bodies: how do we image them? Emerg Radiol 2015; (4): 425–430.

14.

Spiers A, Jamil S, Whan E, Forbes D, Gollow I, Andrews D. Survival of patient after aorto-oesophageal fistula following button battery ingestion. ANZ J Surgery 2012; 82 (3): 186–187.

15.

Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging battery-ingestion hazard: clinical implications. Pediatrics 2010; 125 (6): 1168–1177.

16.

Wright K, Parkins K, Jahn H, Rowlands R, Davies F. Catastrophic haemorrhage from BB ingestion in children: a growing problem. Acta Paediatr 2017;106 (9): 1391-1393.

17.

Heckstall RL, Hollander JE. Aortoesophageal Fistula: Recognition and Diagnosis in the Emergency Department. Ann Emerg Med 1998; 32 (4): 502–505.

18.

Brumbaugh DE, Colson SB, Sandoval JA, Karrer FM, Bealer JF, Litovitz T, et al. Management of Button Battery–induced Hemorrhage in Children. J Pediatr Gastroenterol Nutr 2011; 52 (5): 585.

19.

Jatana KR, Litovitz T, Reilly JS, Koltai PJ, Rider G, Jacobs IN. Pediatric button battery injuries: 2013 task force update. Int J Pediatr Otorhinolaryngol 2013; 77 (9): 1392–1399.

20.

Whelan R, Shaffer A, Dohar JE. Button battery versus stacked coin ingestion: A conundrum for radiographic diagnosis. Int J Pediatr Otorhinolaryngol 2019; 126: 109627.

21.

22.

Sethia R, Gibbs H, Jacobs IN, Reilly JS, Rhoades K, Jatana KR. Current management of BB injuries. Laryngoscope Investig Otolaryngol 2021; 6 (3): 549-563.

23.

Anfang RR, Jatana KR, Linn RL, Rhoades K, Fry J, Jacobs IN. pH-neutralizing esophageal irrigations as a novel mitigation strategy for BB injury. Laryngoscope 2019; 129 (1): 49-57.

24.

25.

Leinwand K, Brumbaugh DE, Kramer RE. BB Ingestion in Children: A Paradigm for Management of Severe Pediatric Foreign Body Ingestions. Gastrointest Endosc Clin N Am 2016; 26 (1): 99-118.

26.

Bendig DW, Mackie GG. Management of Smooth-Blunt Gastric Foreign Bodies in Asymptomatic Patients. Clin Pediatr (Phila) 1990; 29 (11): 642–645.

27.

28.

Seng Loh K, Siang Tan LK, Smith JD, Hian Yeoh K, Dong F. Complications of Foreign Bodies in the Esophagus. Otolaryngol Head Neck Surg 2000;123 (5): 613–616.

29.

30.

31.

Hachimi-Idrissi S, Corne L, Vandenplas Y. Management of ingested foreign bodies in childhood: our experience and review of the literature. Eur J Emerg Med 1998; 5 (3): 319–324.

32.

Panieri E, Bass DH. The management of ingested foreign bodies in children - a review of 663 cases. Eur J Emerg Med 1995;2 (2):83–87.

33.

Lee JH. Foreign Body Ingestion in Children. Clin Endosc 2018; 51 (2): 129-136.

34.

35.

Braumann C, Goette O, Menenakos C, Ordemann J, Jacobi CA. Laparoscopic removal of ingested pin penetrating the gastric wall in an immunosuppressed patient. Surg Endosc 2004;18 (5): 870–870.

36.

Mehran A, Podkameni D, Rosenthal R, Szomstein S. Gastric Perforation Secondary to Ingestion of a Sharp Foreign Body. JSLS 2005; 9(1): 91–93.

37.

Goh BKP, Chow PKH, Quah HM, Ong HS, Eu KW, Ooi LLPJ, et al. Perforation of the Gastrointestinal Tract Secondary to Ingestion of Foreign Bodies. World J Surg 2006; 30 (3): 372–377.

38.

Akçam M, Koçkar C, Tola HT, Duman L, Gündüz M. Endoscopic removal of an ingested pin migrated into the liver and affixed by its head to the duodenum. Gastrointest Endosc 2009; 69 (2): 382–384.

39.

40.

.Karadayı Ş, Şahin E, Nadir A, Kaptanoğlu M. Wandering pins: case report. Cumhuriyet Med J 2009; 31: 300-302

41.

Prasad TS, Low Y, Tan C, Jacobsen A. Swallowed Foreign Bodies in Children: Report of Four Unusual Cases. Ann Acad Med Singap 2006; 35 (1): 49–53.

42.

Madrona AP, Hernández JAF, Prats MC, Riquelme JR, Paricio PP. Intestinal Perforation by Foreign Bodies. Eur J Surg 2000;166 (4): 307–309.

43.

44.

Hameed K, Hassan MK, Rehman S, Khan D, Khan IM, Khattak AK. Management of foreign bodies in the upper gastrointestinal tract with flexible endoscope. J Postgrad Med Inst 2011; 25 (1).

45.

Tokar B, Cevik AA, Ilhan H. Ingested gastrointestinal foreign bodies: predisposing factors for complications in children having surgical or endoscopic removal. Pediatr Surg Int 2007; 23(2):135–139.

46.

47.

48.

49.

50.

Lancashire MJR, Legg PK, Lowe M, Davidson SM, Ellis BW. Surgical aspects of international drug smuggling. Br Med J (Clin Res Ed). 1988; 296 (6628): 1035–1037.

51.

Beno S, Calello D, Baluffi A, Henretig FM. Pediatric Body Packing: Drug Smuggling Reaches a New Low. Pediatr Emerg Care 2005; 21 (11): 744–746.

52.

Popel J, El-Hakim H, El-Matary W. Esophageal foreign body extraction in children: flexible versus rigid endoscopy. Surg Endosc 2011; 25 (3): 919–922.

53.

54.

Sethia R, Gibbs H, Jacobs IN, Reilly JS, Rhoades K, Jatana KR. Current management of button battery injuries. Laryngosc Investig Otolaryngol 2021; 6 (3): 549–563.

55.

56.

Kodituwakku R, Palmer S, Paul SP. Management of foreign body ingestions in children: button batteries and magnets. Br J Nurs Mark Allen Publ 2017; 27; 26 (8): 456–461.

57.

Abstract

Liver cancer is the sixth most common cancer and the third leading cause of cancer-related death. Hepatocellular carcinoma (HCC) accounts for about 90% of cases and mostly arises in chronic liver disease, especially cirrhosis. Viral hepatitis remains a leading cause, but alcohol-related disease and MASLD are rising. With immune checkpoint inhibitors transforming HCC management, it is timely to highlight common mistakes across screening, staging, diagnosis and treatment.

Topics

Digestive Oncology Hepatobiliary

Published

2026

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European Interdisciplinary Guidelines on Pain Management in Acute Pancreatitis: UEG, EPC, EDS, ESDO, EAGEN, ESPGHAN, ESGAR, and ESPCG Evidence-Based Recommendations

Sanjay Pandanaboyana

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Guideline

ABSTRACT

Pain is often the presenting symptom of acute pancreatitis (AP) and has a prognostic significance, with poorly treated pain affecting patient outcomes. Despite this, there are currently no international recommendations for pain management in patients admitted with AP. This current guideline was developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. Nine working groups were formed to develop statements on pain management in AP from admission to discharge. After systematic literature reviews, the evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted using three rounds of Delphi method. The guidelines concluded that acute postoperative pain management guidelines are applicable for treating acute pain due to AP. The numerical rating scale is preferred for pain assessment because of better compliance. Opioids currently form the cornerstone of severe pain management. Potent opioids such as buprenorphine and pentazocine provide superior pain relief over non-opioid medications and decrease the need for rescue analgesia. Current evidence does not consistently demonstrate harm from opioids in AP. In patients with severe pain, safety concerns should not delay the timely use of opioids to ensure adequate pain management. Specific recommendations concerning the use of epidural analgesia, acupuncture and management of pain in the paediatric population and during pregnancy are provided based on evidence and expert opinions. Finally, the unmet needs for future research were discussed and proposed.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

United European Gastroenterology Journal, 2026

Published

2026

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Oesophageal cancer with Massimiliano di Pietro (Part 2)

Massimiliano di Pietro, Pradeep Mundre

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Abstract

Topics

Digestive Oncology Endoscopy Oesophagus

Published

2025

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The European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer: Methodological Protocol

Laura Leeuwenburgh

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Guideline

ABSTRACT

Background

Pancreatic cancer remains one of the most lethal cancers despite extensive efforts and research conducted over the past decades. To effectuate groundbreaking improvements in pancreatic cancer treatment, interdisciplinary and international collaboration is essential. Evidence-based guidelines, including state-of-the-art evidence and expert opinion, are crucial to guide medical specialists, researchers, and patients, especially on issues where consensus is still lacking. This article describes the methodological protocol for the development of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer. The guideline aims to identify current knowledge gaps on pancreatic cancer management, develop questions based on these knowledge gaps, and answer these questions with evidence-based recommendations supplemented, when evidence is lacking, with expert advice for treatment and future research.

Methods

This guideline development protocol is developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The process is structured into six stages: First, 13 theme-based multidisciplinary working groups are established, comprising representatives from 30 European medical and patient societies. Second, these working groups identify the most relevant current knowledge gaps on pancreatic cancer within their theme and formulate key questions. Third, the available evidence to answer these key questions is obtained through systematic reviews and the certainty of evidence is assessed using the GRADE approach. Fourth, recommendations are developed based on the available evidence. Fifth, all participants reach consensus on the recommendations through a modified Delphi process. Sixth, the recommendations are discussed during an open conference, including an external validation committee.

Discussion

This methodological protocol of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer is designed to identify key knowledge gaps across 13 themes and formulate evidence-based recommendations. This guideline initiative unites 30 European medical and patient societies for pancreatic cancer.

Summary

Methodological protocol of an international multi-disciplinary guideline involving 30 European medical and patient societies.
This protocol highlights the six stages of the guideline development process, adhering to the key principles of the GRADE methodology, and thereby aims to maximise transparency and methodological quality.
With addressing knowledge gaps, this guideline will uncover areas with limited evidence. A priority rating for research needs, based on a survey, will be established, highlighting areas where future research is most warranted.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

Clinical and Public Health Guidelines 3 (2026)

Published

2026

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Mistakes in abdominal distension and how to avoid them

Elizabeth Barba Orozco, Alberto Ezquerra-Durán

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Ikenberry SO, Jue TL, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, et al. Management of ingested foreign bodies and food impactions. Gastrointes Endosc 2011; 73 (6): 1085–1091.

Cheng W, Tam PKH. Foreign-body ingestion in children: Experience with 1,265 cases. J Pediatr Surg 1999; 34 (10): 1472–1476.

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Guelfguat M, Kaplinskiy V, Reddy SH, DiPoce J. Clinical Guidelines for Imaging and Reporting Ingested Foreign Bodies. Am J Roentgenol 2014; 203 (1): 37–53.

Tseng HJ, Hanna TN, Shuaib W, Aized M, Khosa F, Linnau KF. Imaging Foreign Bodies: Ingested, Aspirated, and Inserted. Ann Emerg Med 2015; 66 (6): 570-582.e5.

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10.

11.

Spina P, Minniti S, Bragheri R. Usefulness of ultrasonography in gastric foreign body retention. Pediatr Radiol 2000; 30 (12): 840–841.

12.

Hissa M, Al-Edreesi M, Abdi R. Sonographic diagnosis of gastric-outlet foreign body: case report and review of literature. J Family Community Med 2009; 16 (1): 33–36.

13.

Ingraham CR, Mannelli L, Robinson JD, Linnau KF. Radiology of foreign bodies: how do we image them? Emerg Radiol 2015; (4): 425–430.

14.

Spiers A, Jamil S, Whan E, Forbes D, Gollow I, Andrews D. Survival of patient after aorto-oesophageal fistula following button battery ingestion. ANZ J Surgery 2012; 82 (3): 186–187.

15.

Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging battery-ingestion hazard: clinical implications. Pediatrics 2010; 125 (6): 1168–1177.

16.

Wright K, Parkins K, Jahn H, Rowlands R, Davies F. Catastrophic haemorrhage from BB ingestion in children: a growing problem. Acta Paediatr 2017;106 (9): 1391-1393.

17.

Heckstall RL, Hollander JE. Aortoesophageal Fistula: Recognition and Diagnosis in the Emergency Department. Ann Emerg Med 1998; 32 (4): 502–505.

18.

Brumbaugh DE, Colson SB, Sandoval JA, Karrer FM, Bealer JF, Litovitz T, et al. Management of Button Battery–induced Hemorrhage in Children. J Pediatr Gastroenterol Nutr 2011; 52 (5): 585.

19.

Jatana KR, Litovitz T, Reilly JS, Koltai PJ, Rider G, Jacobs IN. Pediatric button battery injuries: 2013 task force update. Int J Pediatr Otorhinolaryngol 2013; 77 (9): 1392–1399.

20.

Whelan R, Shaffer A, Dohar JE. Button battery versus stacked coin ingestion: A conundrum for radiographic diagnosis. Int J Pediatr Otorhinolaryngol 2019; 126: 109627.

21.

22.

Sethia R, Gibbs H, Jacobs IN, Reilly JS, Rhoades K, Jatana KR. Current management of BB injuries. Laryngoscope Investig Otolaryngol 2021; 6 (3): 549-563.

23.

Anfang RR, Jatana KR, Linn RL, Rhoades K, Fry J, Jacobs IN. pH-neutralizing esophageal irrigations as a novel mitigation strategy for BB injury. Laryngoscope 2019; 129 (1): 49-57.

24.

25.

Leinwand K, Brumbaugh DE, Kramer RE. BB Ingestion in Children: A Paradigm for Management of Severe Pediatric Foreign Body Ingestions. Gastrointest Endosc Clin N Am 2016; 26 (1): 99-118.

26.

Bendig DW, Mackie GG. Management of Smooth-Blunt Gastric Foreign Bodies in Asymptomatic Patients. Clin Pediatr (Phila) 1990; 29 (11): 642–645.

27.

28.

Seng Loh K, Siang Tan LK, Smith JD, Hian Yeoh K, Dong F. Complications of Foreign Bodies in the Esophagus. Otolaryngol Head Neck Surg 2000;123 (5): 613–616.

29.

30.

31.

Hachimi-Idrissi S, Corne L, Vandenplas Y. Management of ingested foreign bodies in childhood: our experience and review of the literature. Eur J Emerg Med 1998; 5 (3): 319–324.

32.

Panieri E, Bass DH. The management of ingested foreign bodies in children - a review of 663 cases. Eur J Emerg Med 1995;2 (2):83–87.

33.

Lee JH. Foreign Body Ingestion in Children. Clin Endosc 2018; 51 (2): 129-136.

34.

35.

Braumann C, Goette O, Menenakos C, Ordemann J, Jacobi CA. Laparoscopic removal of ingested pin penetrating the gastric wall in an immunosuppressed patient. Surg Endosc 2004;18 (5): 870–870.

36.

Mehran A, Podkameni D, Rosenthal R, Szomstein S. Gastric Perforation Secondary to Ingestion of a Sharp Foreign Body. JSLS 2005; 9(1): 91–93.

37.

Goh BKP, Chow PKH, Quah HM, Ong HS, Eu KW, Ooi LLPJ, et al. Perforation of the Gastrointestinal Tract Secondary to Ingestion of Foreign Bodies. World J Surg 2006; 30 (3): 372–377.

38.

Akçam M, Koçkar C, Tola HT, Duman L, Gündüz M. Endoscopic removal of an ingested pin migrated into the liver and affixed by its head to the duodenum. Gastrointest Endosc 2009; 69 (2): 382–384.

39.

40.

.Karadayı Ş, Şahin E, Nadir A, Kaptanoğlu M. Wandering pins: case report. Cumhuriyet Med J 2009; 31: 300-302

41.

Prasad TS, Low Y, Tan C, Jacobsen A. Swallowed Foreign Bodies in Children: Report of Four Unusual Cases. Ann Acad Med Singap 2006; 35 (1): 49–53.

42.

Madrona AP, Hernández JAF, Prats MC, Riquelme JR, Paricio PP. Intestinal Perforation by Foreign Bodies. Eur J Surg 2000;166 (4): 307–309.

43.

44.

Hameed K, Hassan MK, Rehman S, Khan D, Khan IM, Khattak AK. Management of foreign bodies in the upper gastrointestinal tract with flexible endoscope. J Postgrad Med Inst 2011; 25 (1).

45.

Tokar B, Cevik AA, Ilhan H. Ingested gastrointestinal foreign bodies: predisposing factors for complications in children having surgical or endoscopic removal. Pediatr Surg Int 2007; 23(2):135–139.

46.

47.

48.

49.

50.

Lancashire MJR, Legg PK, Lowe M, Davidson SM, Ellis BW. Surgical aspects of international drug smuggling. Br Med J (Clin Res Ed). 1988; 296 (6628): 1035–1037.

51.

Beno S, Calello D, Baluffi A, Henretig FM. Pediatric Body Packing: Drug Smuggling Reaches a New Low. Pediatr Emerg Care 2005; 21 (11): 744–746.

52.

Popel J, El-Hakim H, El-Matary W. Esophageal foreign body extraction in children: flexible versus rigid endoscopy. Surg Endosc 2011; 25 (3): 919–922.

53.

54.

Sethia R, Gibbs H, Jacobs IN, Reilly JS, Rhoades K, Jatana KR. Current management of button battery injuries. Laryngosc Investig Otolaryngol 2021; 6 (3): 549–563.

55.

56.

Kodituwakku R, Palmer S, Paul SP. Management of foreign body ingestions in children: button batteries and magnets. Br J Nurs Mark Allen Publ 2017; 27; 26 (8): 456–461.

57.

Abstract

Abdominal distension and bloating are among the most frequently misunderstood complaints in gastroenterology. They are often used as interchangeable terms, a conceptual mistake that continues to drive diagnostic errors and ineffective treatment. According to Rome IV, bloating and distension may represent either a primary disorder of gut–brain interaction (DGBI) or occur as symptoms with other DGBIs, such as irritable bowel syndrome (IBS), functional dyspepsia (FD) or functional constipation (FC).

Topics

Neurogastroenterology & Motility

Citation

Barba-Orozco E and Ezquerra-Durán A. Mistakes in abdominal distension and bloating and how to avoid them. UEG Education 2026; 26: 5-9.

Published

2026

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