An audit of the management of oesophageal stricture in children in Durban, KwaZulu-Natal Province, South Africa

Abstract

Oesophageal strictures (OSs) are common in resource-poor countries. In children, OSs may result from surgery to the oesophagus, such as repair of oesophageal atresia, or following repeated sclerotherapy for oesophageal varices; however, OSs are most commonly caused by chemical injuries. [1] OSs are occasionally seen in children with untreated gastro-oesophageal reflux, most notably in those with neurological impairment, and also after oesophageal infections, especially in HIV-positive children. [1-3] The goals of management are to relieve dysphagia, ensure adequate nutrition for growth and development, and to prevent aspiration pneumonia and recurrence of the stricture by oesophageal dilatation, stenting, or replacement surgery. [4,5] There are several parameters that have been used to define the outcome of patients suffering from OSs, of which the clinical resolution of dysphagia is considered the most relevant. Many patients report significantly improved symptoms shortly after dilatation, but these gradually worsen over time. [1,4,6] The aim of this study was to describe the aetiology and outcomes of the management of OSs in children in Durban, KwaZulu-Natal Province (KZN), South Africa (SA). Methods The study design was approved by the Biomedical Research Ethics Committee of the University of KwaZulu-Natal (ref. no. BE044/14), the Department of Health and the management of Inkosi Albert Luthuli Central Hospital. A retrospective chart review was conducted of all paediatric patients aged <14 years, who had been admitted for management of OSs at Inkosi Albert Luthuli Central Hospital in Durban, KZN, SA from July 2002 to December 2010. Management status at 3 years after presentation was used to define outcome. Data collected from the patients' files were manually entered into a Microsoft Excel spreadsheet. Patient demographics included age, gender, race, comorbidities, aetiological factors, diagnostic investigations, type of endoscope used, location and number of strictures, duration of treatment, complications, recurrence, adjuvant therapy, and patient outcomes. Diagnosis of OS was made endoscopically and radiologically. Operative procedures were performed under general anaesthesia by different paediatric surgeons and trainees. Results Thirty-nine patients were identified and included in our review. Their ages ranged from 1 month to 13 years, and there were 18 (46%) males and 21 (54%) females. Most participants were black South Africans (36 (92%)), in keeping with the demographics of the population served. Eleven children (28%) were HIV-infected, (5%) were HIVexposed, and 23 (59%) children had not been tested for HIV. Strictures secondary to surgical correction of oesophageal atresia (14 (35.9%)) were the most common, followed by OSs due to corrosive injury (12 (30.8%)). HIV-related strictures were seen in 8 (21%) children, while gastro-oesophageal reflux (2 (5%)), and foreign body (FB) ingestion (3 (7.6%)) were less common. The most common stricture site was the middle-third of the oesophagus (51%), with 33.3% i...