pH‐neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury

@article{Anfang2019pHneutralizingEI,
  title={pH‐neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury},
  author={Rachel R Anfang and Kris R. Jatana and Rebecca L Linn and Keith Rhoades and Jared Fry and Ian N Jacobs},
  journal={The Laryngoscope},
  year={2019},
  volume={129}
}
Ingestion of button batteries (BB) can rapidly lead to caustic esophageal injury in infants and children, resulting in significant morbidity and mortality. To identify novel mitigation strategies, we tested common weakly acidic household beverages, viscous liquids, and Carafate® for their ability to act as protective esophageal irrigations until endoscopic removal of the BB. 

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

TLDR
Initial safety data for the human application of intraoperative tissue pH neutralization using 0.25% acetic acid irrigation after BB removal is presented.

In reference to pH‐Neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury

TLDR
Contrary to the authors’ conclusions, it is recommended early use of honey as the first-line agent for reducing esophageal battery-related injury while awaiting battery removal, in view of the superior protective results shown with honey and the potential risks of Carafate.

In reference to pH‐neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury

TLDR
Contrary to the authors’ conclusions, it is recommended early use of honey as the first-line agent for reducing esophageal battery-related injury while awaiting battery removal, in view of the superior protective results shown with honey and the potential risks of Carafate.

Regarding pH‐neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury

TLDR
The results are too preliminary to recommend the systematic administration of honey in patients who have ingested button battery, but use of sterile water may be efficient for preventing BB-induced esophageal lesions by diluting the ion content and limiting the conductivity.

In response to letter to the editor regarding: pH‐neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury

TLDR
The dual action of barrier protection and pH neutralization was established, which was accomplished using higher viscosity weakly acidic liquids and not only halted the injury progression at the time of development but also improved tissue architecture 7 days out by promoting a more robust healing response in severely injured areas.

In Response to pH‐Neutralizing Esophageal Irrigations as a Novel Mitigation Strategy

TLDR
It is too soon to designate a first-line recommendation of honey alone, but both honey and sucralfate (Carafate) were equally effective during in vitro and in vivo animal studies, and both can help slow the rate of BB injury.

Mitigating Risks of Swallowed Button Batteries: New Strategies Before and After Removal.

TLDR
Gastroenterologists need to be aware of the updates to the National Capital Poison Center algorithm for button battery ingestion and initiation of sucralfate or honey shortly after some button battery ingestions is crucial to prevent further injury while awaiting emergent removal.

Anesthetic Implications of the New Guidelines for Button Battery Ingestion in Children

TLDR
Given that anesthesiologists play an important role in the management of esophageal foreign body removal, the entire specialty needs to be aware of the supporting data behind this and general perioperative considerations for management and potential complications of button battery ingestion.

Electric Insulating Irrigations Mitigates Esophageal Injury Caused by Button Battery Ingestion

TLDR
Irrigations with olive oil alone couldn’t prevent the BB discharge and is harmful for BB ingestion before surgical removal, however, mixed with honey, olive oil very effectively prevents the BB discharging and produces better esophageal protection than honey.

Button battery taping prevents oesophageal injury

TLDR
The aim was to determine if tape could prevent oesophageal injury in a cadaveric porcine model and whether this practice prevents injury.
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