Available online 11 February 2026, 151584

Dynamic in vitro model mimics esophageal structure, peristalsis, and saline perfusion.

Oral honey before battery removal significantly protects esophageal mucosa.

Irrigation with 0.25% acetic acid offers no mucosal benefit in this study.

Retained esophageal button batteries (BBs) cause significant morbidity in children. Current guidelines recommend oral honey administration in children over 1 year and esophageal irrigation with 0.25% acetic acid (ACA) after BB removal, but supporting evidence is limited. We aimed to develop a dynamic in vitro esophageal model to evaluate these interventions.

Our novel model consisted of fresh porcine oesophagi suspended in an environment simulating body temperature, peristalsis, and saline perfusion. BBs or sham BBs were placed in the oesophagus. Honey was administered at specific intervals after BB insertion. After BB removal, the lesions were washed with ACA or buffer solution. Paraffin slides were stained with hematoxylin and eosin (HE) to quantify the ulceration.

The mean pH was significantly lower in samples exposed to honey (p≤0.0001) and the voltage discharge was reduced with honey as well (p≤0.0001). Application of honey resulted in macroscopically smaller ulcers than in untreated oesophagi. HE staining confirmed the macroscopic results with significantly reduced ulcers with honey application (p<0.009). Irrigation with ACA had no effect.

We developed a dynamic in vitro model of oesophageal button battery ingestion by including peristalsis, body temperature, an upright lumen and saline perfusion. Our data supports the recommendations that oral honey application before endoscopic battery removal protects the mucosa after oesophageal BB retention, whereas ACA irrigation at the time of BB removal showed no effect in this study.

Button battery, honey

acetates, ulcer, body temperature, peristalsis, child

© 2026 The Author(s). Published by Elsevier Inc.