Corrosive upper gastrointestinal strictures in children: Difficulties and dilemmas

Abstract

Children constitute 80% of all corrosive ingestion cases. The majority of this burden is contributed by developing countries. Accidental ingestion is common in younger children (< 5 years) while suicidal ingestion is more common in adolescents. The severity of injury depends on nature of corrosive (alkali or acid), pH, amount of ingestion and site of exposure. There are multiple doubts and dilemmas which exist in management of both acute ingestion and chronic complications. Acute ingestion leads to skin, respiratory tract or upper gastrointestinal damage which may range from trivial to life threatening complications. Esophagogastroduodenoscopy is an important early investigation to decide for further course of management. The use of steroids for prevention of stricture is a debatable issue. Upper gastrointestinal stricture is a common long-term sequelae of severe corrosive injury which usually develops after three weeks of ingestion. The cornerstone of management of esophageal strictures is endoscopic bougie or balloon dilatations. In case of resistant strictures, newer adjunctive therapies like intralesional steroids, mitomycin and stents can be utilized along with endoscopic dilatation. Surgery is the final resort for strictures resistant to endoscopic dilatations and adjunctive therapies. There is no consensus on best esophageal replacement conduit. Pyloric strictures require balloon dilatation , failure of which requires surgery. Patients with post-corrosive strictures should be kept in long term follow-up due to significantly increased risk of carcinoma. Despite all the endoscopic and surgical options available, management of corrosive stricture in children is a daunting task due to high chances of recurrence, perforation and complications related to poor nutrition and surgery.

Endoscopic Treatment for Pediatric Esophageal Stenosis Induced by Chemical Burn, Congenitally, or After Surgical Repair of Esophageal Atresia

“…In this study, the median treatment interval was significantly longer in the EBD+stenting group than in the EBD group (10 vs. 4 months), which also confirmed the importance of stent placement after EBD. However, the migration rate after esophageal stent placement is high (22), and the possible complications including chest pain, reflux esophagitis, stent shedding, granulation tissue hyperplasia should not be ignored (23).…”

“…In summary, EBD is suggested as the first and regular treatment step for children with esophageal stenosis shorter than 5 cm (22). Endoscopic stent placement is superior in maintaining continuous, radially oriented dilation pressures, and can serve as the first-line treatment for stenosis longer than 5 cm or recurrent stenosis.…”

Usefulness of a novel narrow-diameter endoscope for endoscopic balloon dilation of esophageal strictures

“…Esophageal stricture is a narrowing of the esophageal lumen, often causing esophageal obstruction 1 2 . Dilation of strictures by endoscopy using balloon dilation is indicated to restore the patency of the esophageal lumen 3 . We present the case of a 55-year-old Japanese man who presented with chest discomfort.…”

First experience with a supercharged pedicled jejunal interposition for esophageal replacement after caustic ingestion in a middle-income Latin American country

“…Between 5000 and 18,000 cases of digestive tract lesions caused by ingestion of caustic or corrosive substances are reported yearly in the United States, from which around 80 % occur in young children, the remaining cases are mostly related to self-inflicted aggressions. Suicide attempt injuries of this nature are frequently life-threatening [1] . In developing countries, the incidence of severe caustic gastrointestinal lacerations is high and has been associated with social, economic, and educational factors.…”

“…In developing countries, the incidence of severe caustic gastrointestinal lacerations is high and has been associated with social, economic, and educational factors. Despite efforts to regulate the situation and educate the population, this type of injury still constitutes an important and frequently unreported public health issue, especially in low- and middle-income countries [1] , [2] .…”