An Unexpected Benefit of the Cashless Society: Cash Use and Endoscopic Oesophageal Foreign Body Removal in England

BackgroundReduced cash use could decrease children's access to coins and subsequent oesophageal foreign body removal.We examined national trends while distinguishing anatomical coding and endoscopic technique. MethodsPublic Hospital Episode Statistics for England, 2014/15-2024/25, were compared with United Kingdom cash payment shares for 2014-2024.Primary-procedure episodes for flexible and rigid oesophageal removal were combined; children aged 0-14 years and broader upper gastrointestinal coding were examined separately.Correlations of annual levels and first differences were descriptive. ResultsOesophageal episodes decreased from 1,615 to 1,174 (27.3%), including a reduction from 563 to 330 (41.4%) in children.Cash share decreased from 48% to 9%.Annual-level correlations were strong (all ages, r=0.935; children, r=0.899), whereas first-difference correlations were 0.066 and -0.440.Including broader upper gastrointestinal removal reversed the all-age trend: 3,135 to 3,901 episodes (24.4% increase). ConclusionsDeclining oesophageal removal coincided with declining cash use, but reductions were not proportional.Whilst these aggregate data cannot identify swallowed coins or establish definite causation, they support the hypothesis that an upward trend in cashless payments caused fewer removals of oesophageal foreign bodies.