Battery Ingestion in Children, an Ongoing Challenge: Recent Experience of a Tertiary Center.

Introduction: Morbidity related to childhood battery ingestions (BI) has increased recently due to the expanding use of larger lithium cells. A prompt endoscopic removal is vital to prevent severe complications in cases of esophageal batteries (EB). Materials and Methods: A retrospective, descriptive study of admissions for BI requiring endoscopic removal in a tertiary hospital's pediatric emergency department (Jan. 2011/Dec. 2020). Results: We had 35 cases, with an increasing incidence in the last 6 years; median age, 26 m (8 m-10 years), witnessed ingestion in 86%. On the X-ray: 14 (40%) had an EB, 21 (60%), a gastric battery (GB). Symptoms were present in 57% (100% EB/24% GB), and vomiting was the most frequent (50%). Endoscopy revealed: EB, 13 (37%); GB, 17 (49%); duodenal battery, 1 (3%); no battery, 4 (11%). Median time to removal: EB, 7 h (2 h-21days); GB, 12 h (2 h-3 days). All the patients with EB on the X-ray (14) had severe mucosal injury (Zargar classification): Grade IIIa, 7 (50%); IIIb, 5 (36%); IV, 2 (14%). CT-scan showed perforation in 2 patients (total, 4; 29% of EB). In patients with GB (21), 14 (67%) had mucosal damage; 13 (93%), mild (< Grade III, two esophageal erosions); 1 (7%) IIIa (esophageal ulceration). A statistically significant association between exposure time, younger age or battery size and severity of endoscopic lesions was found in EB location. There were no mortality cases. Acute complications occurred in 57% of EB: infection, 50%; perforation, 29%; pneumomediastinum/stridor, 14%; pneumothorax/subglottic stenosis/hemodynamic instability, 7 vs. 0% GB. Stenosis subsequently developed in 6 (43%) of EB: mild, 4 cases (29%); severe, 2 cases (14%, one resolved after endoscopic dilation; one needed a gastrostomy and esophagocoloplasty). Conclusion: We verified recent increase in admissions due to battery ingestions and associated complications, despite the availability of an emergency pediatric endoscopy team. The patients with EB had more severe mucosal injury and poorer short/long-term outcomes. Children with GB had milder lesions, although the presence of a GB did not exclude esophageal injury. The availability of actual data from national referral centers will support advocacy efforts among stakeholders, including industry representatives and policy makers, in preventing worldwide button battery injury.

Emergency endoscopy in pediatrics during the SARS-CoV-2 pandemic in a tertiary center - A changing pattern?

A retrospective analysis of admissions to the pediatric emergency department that required emergency endoscopy was performed, to evaluate if changes in the lifestyle and hospital practices imposed by the pandemic had an impact on the frequency and profile of the emergency endoscopy. The first 6 months of the pandemic (Group A) were compared with the homologous period of the previous year (Group B). Eight-nine cases were analyzed. Most emergency endoscopies occurred in children under the age of two (28%) and most of these were in Group A (p = 0.009). More foreign bodies were removed in Group A (p = 0.026). There were no statistically significant differences in the time to reach the emergency department (p = 0.934) or in the time delay since emergency room admission until the endoscopic procedure (p = 0.266). Overall, the pandemic did not seem to affect the quality of healthcare practice regarding emergency endoscopic procedures.

Efficacy of Exclusive Enteral Nutrition in Pediatric Crohn’s Disease

Introduction: Exclusive enteral nutrition (EEN) is recommended as first line therapy for mild to moderate Crohn’s disease (CD) to induce remission in pediatric patients. It involves the use of a whole protein formula given exclusively for six to eight weeks. Aims: To report the preliminary experience of a tertiary care center in Portugal, concerning the efficacy and tolerance of EEN in pediatric patients with CD. Materials and methods: Retrospective descriptive study of pediatric CD patients who received EEN as induction of remission therapy between January/2014 and June/2019. Clinical and laboratory parameters were assessed, including clinical disease activity and nutritional status before and immediately after treatment. Results: In the study period, 37 patients were diagnosed with CD; 19 were included in the study, 17/19 (89.5%) completed the EEN therapy and 16/17 (94%) achieved clinical remission. Ten patients were male, with a median (IQR) age of 14.2 years (11.8; 16.7 years). The majority of the patients had ileocolonic disease (47.4%) or ileocecal disease (42.1%) and an inflammatory behavior (78.9%). None of the patients had growth delay at diagnosis. All patients received EEN orally for six to eight weeks, 18 used polymeric formulas and one used an elemental formula. Comparing data at baseline and after treatment, significant improvements were observed in BMI Z-score (p=0.002), PCDAI score (p<0.001), erythrocyte sedimentation rate (p=0.002), C-reactive protein (p=0.003), faecal calprotectin concentration (p=0.036), and serum albumin (p=0.020). No side effects were noticed. Discussion/Conclusion: In this series, EEN therapy was associated to significant improvement of disease activity index, nutritional status, weight gain and decreased markers of inflammation in most patients. Our data are in accordance with previous observations that EEN is an effective and well tolerated treatment for the induction of remission in pediatric patients with CD. (AU)

Secondary syphilis mimicking inflammatory bowel disease.

This study reports the case of a 15-year-old male patient with extensive anal inflammation, cobblestone-like mucosa and areas of ulceration, loose bloody stool and weight loss for 8 weeks, suggestive of inflammatory bowel disease. Genital lesions of syphilides were later observed and Venereal Disease Research Laboratory test was positive, thus benzyl penicillin treatment was prescribed with total resolution of genital and bowel symptoms.