Abstract Objective To assess the first lithium coin‐cell battery (CCB) technology on the consumer market with ingestion burn protection claims in context of medical management practices. Study Design Cadaveric porcine esophageal model. Setting Tertiary care children's hospital research institute and third‐party laboratory. Methods Anterior‐posterior X‐ray imaging was performed. Using in vitro porcine tissue segments, traditional CCBs and protective CCBs were assessed for visible appearance and surface pH over 60 minutes; another group was assessed for 24 hours. A separate experiment evaluated existing protocols to administer honey/sucralfate and perform 0.25% acetic acid irrigation. Results All protective CCBs demonstrated diagnostic double‐ring/halo sign on X‐ray. Traditional CCBs demonstrated diffusely highly alkaline pH of 13 and significant tissue necrosis. For protective CCBs, regions of tissue pH increased to 12‐13; however, substantially reduced tissue injury without obvious necrosis was noted. At 24 hours, protective CCBs compared to traditional CCBs maintained reduced visible tissue injury at both positive and negative poles. Honey, sucralfate or 0.25% acetic acid irrigations effectively neutralized pH. Conclusion To our knowledge, this is the first study in the medical literature to assess recently marketed protective CCBs. X‐ray diagnosis, preremoval honey/sucralfate use, emergent removal for esophageal lodgment, postremoval 0.25% acetic acid esophageal irrigation practices should not change. While protective CCBs showed substantial reduction of injury severity, the highly alkaline pH at negative pole still warrants neutralization treatments and further study. Widespread adoption of advanced technologies for child safety across the battery, electronics, and consumer goods industries could prevent severe injuries or deaths.

OBJECTIVES:Pediatric esophageal button battery (BB) injury occurs rapidly and continues to be a significant source of morbidity and mortality. Unfortunately, a BB that no longer supplies power to a device can still have enough residual voltage to cause injury within the body. Development of additional prevention strategies for consumers may reduce esophageal injury risk.METHODS:In this study, 24 commercially available button batteries (BBs) were horizontally and vertically wrapped (2 layers, full circumferential coverage, 90° apart) with 6 different types of common household tapes (Scotch®/clear, Scotch®/Magic, masking tape, packing tape/clear, packing tape/brown, black electrical tape) and left at room temperature for 30 days. In addition, 6 of the CR2032 batteries covered with each type of tape were placed in a cadaveric piglet esophageal model for a 4-h period and then compared to controls without tape for tissue pH changes and visible tissue injury.RESULTS:None of the tape-wrapped batteries showed voltage changes nor presented any hazard stemming from BB ingestion. All 6 tape covered batteries placed in the cadaveric piglet esophageal tissue model demonstrated no visible tissue injury and no change in tissue pH in contrast to the controls. Review of BB packaging language from various brands of commercially available CR2032 batteries showed that none had specific disposal recommendations.CONCLUSION:Both BB and electronics manufacturers should consider instructing the use of common household tape options to cover these BB immediately after removal from a device for either recycling or disposal. Such precautions may help to reduce related ingestion injuries in children.

Button batteries (BB) are found in common household items and can lead to significant morbidity and mortality in the pediatric population when ingested. BBs are made of various chemistries and have a unique size and shape that yield significant injury when lodged in the pediatric esophagus. BBs create a local tissue pH environment of 10 to 13 and can induce liquefactive necrosis at the negative pole. This initial injury can progress with further tissue breakdown even after removal. Unfortunately, patients may present with vague symptoms similar to viral illnesses and there is not always a known history of ingestion. Plain film X-ray can be diagnostic. Exposure can lead to caustic injury within 2 hours. Thus, timely endoscopic removal is the mainstay of treatment. Novel mitigation and neutralization strategies have been implemented into treatment guidelines. These include the preremoval ingestion of honey or sucralfate and intraoperative irrigation with acetic acid. Depending on the severity of injury following removal, careful consideration should be given for potential delayed complications including fistulization into major vessels which often leads to death. The National Button Battery Taskforce and several industry members have implemented prevention strategies such as educational safety outreach campaigns, child-resistant packaging changes, and warning labels. Governmental regulation and industry changes are key to limit not only the amount of BB ingestions, but also the devastating consequences that can result. Anonymous reporting of BB injuries through the Global Injury Research Collaborative has been made convenient and centralized through the advent of a user-friendly smartphone iOS/App Store and Android/GooglePlay application called the "GIRC App"; all specialists who manage foreign body cases should contribute their cases to help prevent future injuries. BB ingestion must be recognized and treated promptly using a multidisciplinary approach to optimize outcomes for these patients. Ultimately, a safer BB technology is critically needed to reduce or eliminate the severe and life-threatening injuries in children. Level of Evidence 5

Button batteries (BBs) are a severe potential hazard present in house-hold settings, and BB injuries in children continue to be a significant source of morbidity and mortality. When lodged in the body, BBs can cause serious injury within as little as 2 hours. Without a known history of BB ingestion, the diagnosis can be challenging because symptoms may be nonspecific and mimic common viral illnesses seen in children. Based on recent research on esophageal BBs, novel mitigation strategies can be used in the urgent care and emergency department settings, or during transport between facilities <12 hours from ingestion. These include the preremoval use of honey or sucralfate to help decrease the rate of esophageal tissue injury. All emergency care providers should be aware of these interventions for esophageal BB and help to expedite these children to the operating room for removal.

Foreign body (FB) and caustic ingestion events are common conditions managed by pediatric gastroenterologists. Several publicly accessible options exist for providers to report pediatric ingestions. However, industry has deemed existing data sources insufficient for some hazards to justify product safety changes. The objectives of this study were: 1) to capture ingestion injury reporting practices among pediatric gastroenterologists and 2) to discuss a solution.

The LaryngoscopeVolume 129, Issue 5 p. E163-E164 Broncho-Esophagology In Response to pH-Neutralizing Esophageal Irrigations as a Novel Mitigation Strategy Rachel R. Anfang, Rachel R. Anfang Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PennsylvaniaSearch for more papers by this authorKris R. Jatana MD, Corresponding Author Kris R. Jatana MD Kris.Jatana@nationwidechildrens.org orcid.org/0000-0002-8475-9780 Department of Otolaryngology–Head and Neck Surgery, Nationwide Children's Hospital and Wexner Medical Center at Ohio State University, Columbus, OhioSend correspondence to Kris R. Jatana, MD, Pediatric Otolaryngology, Nationwide Children's Hospital, 555 South 18th Street, Suite 2A, Columbus, OH 43205. Ph: 614-722-6600; Fax: 614-722-6609; E-mail: Kris.Jatana@nationwidechildrens.orgSearch for more papers by this authorRebecca L. Linn MD, Rebecca L. Linn MD Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PennsylvaniaSearch for more papers by this authorKeith Rhoades BS, Keith Rhoades BS Intertek Product Intelligence Group Inc., Arlington Heights, IllinoisSearch for more papers by this authorJared Fry BS, Jared Fry BS Intertek Product Intelligence Group Inc., Arlington Heights, IllinoisSearch for more papers by this authorIan N. Jacobs MD, Ian N. Jacobs MD Division of Otolaryngology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PennsylvaniaSearch for more papers by this author Rachel R. Anfang, Rachel R. Anfang Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PennsylvaniaSearch for more papers by this authorKris R. Jatana MD, Corresponding Author Kris R. Jatana MD Kris.Jatana@nationwidechildrens.org orcid.org/0000-0002-8475-9780 Department of Otolaryngology–Head and Neck Surgery, Nationwide Children's Hospital and Wexner Medical Center at Ohio State University, Columbus, OhioSend correspondence to Kris R. Jatana, MD, Pediatric Otolaryngology, Nationwide Children's Hospital, 555 South 18th Street, Suite 2A, Columbus, OH 43205. Ph: 614-722-6600; Fax: 614-722-6609; E-mail: Kris.Jatana@nationwidechildrens.orgSearch for more papers by this authorRebecca L. Linn MD, Rebecca L. Linn MD Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PennsylvaniaSearch for more papers by this authorKeith Rhoades BS, Keith Rhoades BS Intertek Product Intelligence Group Inc., Arlington Heights, IllinoisSearch for more papers by this authorJared Fry BS, Jared Fry BS Intertek Product Intelligence Group Inc., Arlington Heights, IllinoisSearch for more papers by this authorIan N. Jacobs MD, Ian N. Jacobs MD Division of Otolaryngology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PennsylvaniaSearch for more papers by this author First published: 11 February 2019 https://doi.org/10.1002/lary.27754Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume129, Issue5May 2019Pages E163-E164 RelatedInformation

Objectives/HypothesisIngestion 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.Study DesignCadaveric and live animal model.MethodsApple juice, orange juice, Gatorade®, POWERADE®, pure honey, pure maple syrup, and Carafate® were screened using a 3 V lithium (3 V‐CR2032) BB on cadaveric porcine esophagus. The most promising in vitro options were tested against a saline control in live American Yorkshire piglets with anode‐facing placement of the BB on the posterior wall of the proximal esophagus for 60 minutes. BB voltage and tissue pH were measured before battery placement and after removal. The 10 mL irrigations occurred every 10 minutes from t = 5 minutes. Gross and histologic assessment was performed on the esophagus of piglets euthanized 7 ± 0.5 days following BB exposure.ResultsHoney and Carafate® demonstrated to a significant degree the most protective effects in vitro and in vivo. Both neutralized the tissue pH increase and created more localized and superficial injuries; observed in vivo was a decrease in both full‐thickness injury (i.e., shallower depths of necrotic and granulation tissue) and outward extension of injury in the deep muscle beyond surface ulcer margins (P < .05).ConclusionsIn the crucial period between BB ingestion and endoscopic removal, early and frequent ingestion of honey in the household setting and Carafate® in the clinical setting has the potential to reduce injury severity and improve patient outcomes.Level of EvidenceNA Laryngoscope, 129:49–57, 2019

Button battery (BB) injuries continue to be a significant source of morbidity and mortality, and there is a need to confirm the mechanism of injury for development of additional mitigation strategies.