Mask Anesthesia, Straight Laryngoscope, and Alligator Forceps for Cervical Esophageal Coin Removal: A Comparison with Traditional Methods

Objective(s): Coins are the most frequently ingested foreign bodies by children. While rigid esophagoscopy with concomitant intubation is frequently used for removal, it has the potential for serious complications. We aimed to assess and compare the safety, efficacy, and efficiency of two different techniques for pediatric cervical esophageal coin removal. Methods: Retrospective chart review identified patients who underwent esophageal coin removal from January 2017—August 2023 at one of two tertiary academic centers: Ann & Robert H. Lurie Children’s Hospital and Yale-New Haven Hospital. Patients with foreign bodies other than coins were excluded. Patients underwent one of two approaches for cervical esophageal coin removal depending on surgeon preference: (1) induction of general anesthesia, intubation, rigid esophagoscopy, and coin extraction with optical forceps (esophagoscope group) or (2) mask ventilation, insertion of a straight laryngoscope blade into the esophagus orifice, and coin extraction with alligator forceps (straight laryngoscope group). Primary outcomes were successful removal of the esophageal coin, regarded a marker of efficacy, as well as operative and anesthesia times, which were regarded as measures of efficiency. Secondary outcomes were postoperative complications, regarded as markers of safety. Results: Of the 108 patients meeting inclusion criteria, 23 (21.3%) were in the straight laryngoscope group and 85 (78.7%) in the esophagoscope group. Mean operative time was significantly shorter for the straight laryngoscope group compared to the esophagoscope group (2.8 ± 1.5 minutes vs 13.8 ± 17.2 minutes, respectively, p <.0001). Mean anesthesia time was significantly shorter for the straight laryngoscope group compared to the esophagoscope group (24.2 ± 6.4 minutes vs 44.7 ±1 6.2 minutes, respectively, p <.0001). There were no intra- or post-operative complications in the straight laryngoscope group and two minor complications in the esophagoscope group. Conclusions: Esophagoscopy using a straight laryngoscope blade under mask anesthesia can represent a safe and efficient alternative for impacted esophageal coin removal.