Glucagon use for esophageal coin dislodgment in children: A prospective, double-blind, placebo-controlled trial

Objective: Prospective evaluation of the use of glucagon in dislodgment of impacted esophageal coins in children. Methods: This was a double-blind, placebo-controlled study with an open-label second phase in children 1 to 8 years of age who presented to a pediatric emergency department with a radiographically confirmed single esophageal coin impaction. One milligram of glucagon or placebo was given intravenously in double-blinded fashion. Patients were placed in an upright position and asked to drink 2-3 ounces of water. A repeat radiograph was obtained to check coin position in 30-60 minutes. Patients who did not respond were given 1 mg of open-label glucagon intravenously. The glucagon and placebo groups were compared. Results: Fourteen patients were enrolled in the study (the predetermined sample size was not pursued due to inefficacy). Nine patients were in the glucagon group, and five were in the placebo group. Six patients received an additional open-label glucagon dose. The two groups were not different in age (mean, 5.5 years and 4.5 years, respectively), coin position, time between ingestion and presentation (p = 0.45), or time between treatment and repeat radiograph (p = 0.29). In patients who received glucagon, two of 15 (15%) passed the coin into the stomach. In the placebo group, three of five (60%) passed the coin, an inversely significant ratio. Five of six patients who received open-label glucagon were from the initial glucagon group. There were no responders among patients in this group. Conclusions: Glucagon does not appear to be effective in the dislodgment of esophageal coins in children.