Cost analysis in the management of esophageal coins: Endoscopy versus bougienage

Purpose: The aim of this study was to compare the safety, efficiency, and overall cost effectiveness of esophageal bougienage Versus endoscopy in the retrieval of ingested coins. Methods: Retrospective review of patients treated for esophageal coin ingestion at Children's Hospital of Wisconsin over a 1-year period using bougienage or endoscopic retrieval was conducted. (inclusion criterion) Results: Twenty-seven patients were evaluated over the 1-year study period. Two patients spontaneously passed the coins before arrival and needed no further treatment. Twelve patients met criteria for bougienage, and this treatment was successful in 10 of the 12 patients. Mean length of hospital Stay was 2.15 hours, and the mean cost was $546. Thirteen patients were treated successfully with endoscopy. The mean length of hospital stay was 22.7 hours, and the mean cost was $5,230. There were no complications in any of the 25 patients. Conclusions: Bougienage is equally safe, more efficient, and much less expensive than endoscopy for treatment of esophageal coins in properly selected patients. Nearly half of the patients were excluded from bougienage because of delayed presentation alone. Education of parents and physicians regarding symptoms of coin ingestion would allow primary treatment with bougienage in the majority of cases. Copyright (C) 1999 by W.B. Saunders Company.