We appreciate the interest shown by Drs Marcus and Joseph in our study.1 As we stated, "our data show that children with coins in the proximal or middle third of the esophagus are unlikely to pass them into the stomach." None of the 58 such children in our study did so, despite a 15.5-hour median waiting period for the 88% for whom waiting times were known. Although it is possible that one or more of these coins could have passed into the stomach during a uniform 24-hour waiting period, the retrospective nature of our study did not allow us to examine this possibility. We are aware of only one reported passage of a proximal esophageal coin.2
As Dr Marcus notes, the costs of obtaining radiographs on all patients who have swallowed coins may indeed be formidable. The savings generated by early identification of just a few
Conners GP, Chamberlain JM, Ochsenschlager DW. Symptoms and Spontaneous Passage of Esophageal Coins-Reply. Arch Pediatr Adolesc Med. 1995;149(11):1286–1287. doi:10.1001/archpedi.1995.02170240103026
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