Early bougienage for relief of stricture formation following caustic esophageal burns

Abstract

Accidental ingestion of corrosive substances remains a major health hazard in children. Most infants and children who ingest caustic substances present with very few symptoms or signs. Approximately 40% of caustic substance ingestions result in esophageal injury, but the optimal management of caustic esophageal burns remains controversial, with different treatment modalities in use. The aim of this study was to compare the results of prophylactic early bougienage with dilatation that was begun after stricture development. We retrospectively analyzed the management of 125 pediatric cases of corrosive substance ingestion. For children seen primarily at our institution, initial management consisted of prompt endoscopy. Of 125 children admitted with a history of caustic substance ingestion, 54 were found to have esophageal burns, and 32 underwent treatment for stricture formation. Patients with severe injury were divided into two groups: In group A, consisting of 20 patients, prophylactic early dilatation had been done. In the eight patients in group B, dilatation had begun after stricture development. The strictures had resolved after 6 months of dilatation in patients initially treated with prophylactic early bougienage, whereas in patients in whom dilatation began after stricture development, stricture resolution did not occur for more than a year. The goal of initial treatment is to avoid stricture formation. Although early dilatations do not eliminate stricture formation completely, the stricture can resolve more easily with early bougienage.

High Doses of Methylprednisolone in the Management of Caustic Esophageal Burns

“…19,20 In our study, the stricture development percentage was 20.8% among all the patients. The lower percentages observed in our study compared with the literature may be associated with the exclusion of the grade IIIa and IIIb patients from our study.…”

Management of gastrostomy to prevent perforation in acute severe corrosive esophagitis and gastritis: An experimental study

“…Hydroxyl ions in the alkaline chemicals rapidly bind to free hydrogen in the tissues, and within 2-3 days cause thrombosis, tissue necrosis, bacterial infiltrations, and fatty suppurations in the tissues. Alkaline agents mainly cause burns in the esophagus, but when they reach the stomach, they can be neutralized by the acid in the stomach and lose their harmful effects to a greater extent (13). When alkaline agents are swallowed, reflex spasms occur in the esophagus and result in injury in the mediastinum.…”

Prevention of ingestion injuries in children

“…[17,18] Injury depends on the chemical concentration and volume, the tissue surface area and the duration of exposure. Among the most common serious long-term sequelae is oesophageal stricture formation (7 -25%), [12,17] which occurs when submucosal penetration of the burn involves >50% of the lumen.…”