Corrosive esophageal stricture: safety and effectiveness of balloon dilation.

Song, Ho Young; Han, Young Min; Kim, Hak Nam; Kim, Chong Soo; Choi, Ki Chul

doi:10.1148/radiology.184.2.1620830

Cited by 52 publications

(37 citation statements)

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“…In the case of balloon dilation, the corrosive strictures have a higher rate of esophageal perforation than a postoperative stricture. In corrosive stricture patients, extra caution must be taken during balloon dilation in order to avoid an esophageal perforation (3).…”

Section: Discussionmentioning

confidence: 99%

Conservative Treatment of Transmural Perforation with Mediastinal Leakage after Balloon Dilation: A Case Report

Kwak

Han

Chung

2005

J Korean Radiol Soc

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The incidence of esophageal perforations during balloon dilation is 0 14% (1 3). An esophageal perforation is classified into three types: a type I-intramural perforation; a type II-transmural perforation; and a type IIItransmural perforation with mediastinal leakage (4). Fasting, parenteral alimentation, and antibiotics are generally used to treat types-I and II esophageal perforations. However, a type III esophageal perforation showing progressive clinical deterioration needs to be treated surgically (4, 5). There are no reports of a successful conservative treatment for a type III esophageal rupture after esophageal balloon dilation.We report a case of a successful conservative, non-surgical treatment for a transmural perforation with mediastinal leakage after a balloon dilation. Case ReportA 43-year-old man was admitted to our institution complaining of intermittent swallowing difficulties with an 11 year duration. The patient had received a subtotal gastrectomy with an esophagogastrostomy 11 years earlier due to a bleeding ulcer in the gastric fundus, and had subsequently experienced severe swallowing difficulties for seven days. One year after surgery, the patient received an esophageal stent at the anastomotic site because the site showed a severe focal stenosis. However, the stent was removed two weeks after placement under endoscopic guidance on account of its upward migration. Subsequently, the patient's swallowing difficulty improved markedly from 2 (intolerance to soft food) to 0 (regular feeding). The patient had received esophagography at a local clinic due to swallowing difficulties. The esophagography showed severe focal stenosis at the anastomotic site (Fig. 1). A 43-year-old man was admitted complaining of swallowing difficulties. The esophagography revealed severe stenosis at the esophagogastric anastomotic site. Esophagography after balloon dilatation showed a transmural perforation with mediastinal leakage. The patient was treated conservatively for one week at which time the esophagography showed no further leakage at the anastomotic site and the good passage of barium. A 2-year follow-up chest computed tomography (CT) showed good patency of the esophageal lumen and the marked resorption of barium in the mediastinum.

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Section: Discussionmentioning

confidence: 99%

Conservative Treatment of Transmural Perforation with Mediastinal Leakage after Balloon Dilation: A Case Report

Kwak

Han

Chung

2005

J Korean Radiol Soc

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“…Dilatation can be carried out with balloon or bougies (usually Savary) without a clear advantage for each method. However, the failure rate after pneumatic dilatation is higher in caustic ingestion-related strictures than in other benign strictures; Savary bougies are considered more reliable than balloon dilators in consolidated and fibrotic strictures such as old caustic stenosis or in long, tortuous strictures, and may offer the operator the advantage of feeling the dilatation occurring under his hands [45][46][47][48][49][50].…”

Section: Endoscopic Managementmentioning

confidence: 99%

“…The perforation rate after dilatation of benign esophageal strictures varies between 0.1% and 0.4%, but for caustic strictures it fluctuates from 0.4% to 32.0%, dropping from 17.6% to 4.5% with increased experience [4,16,[45][46][47][48][49][50]. The interval between dilatations varies from less than 1 to 2-3 weeks and usually 3-4 sessions are considered sufficient for durable results, although the number of dilatations required may be unpredictable and quite high.…”

Section: Endoscopic Managementmentioning

confidence: 99%

Corrosive Injury of the Upper Gastrointestinal Tract: A Review

Arunachalam¹,

Rammohan²

2016

Arch Clin Gastroenterol

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Ingestion of a corrosive substance can produce severe injury to the gastrointestinal tract and can even result in death. The degree and extent of damage depends on several factors like the type of substance, the morphologic form of the agent, the quantity, and the intent. In the acute stage, perforation and necrosis may occur. Long-term complications include stricture formation in the esophagus, antral stenosis and the development of esophageal carcinoma. Endoscopy should be attempted and can be safely performed in most cases to assess the extent of damage. Procedure related perforation is rare. Stricture formation is more common in patients with second and third degree burns. This review summarizes our current knowledge and evidence based management of this unique but not uncommon pathology of the upper gastrointestinal tract.

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“…The perforation rate in esophageal dilatation is reported to be 0.1-0.4% (3,4), but the risk of perforation increases in irregular, longer and high-grade strictures (5), with a reported perforation rate of up to 32% of patients after dilatation of caustic strictures (6,7).…”

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confidence: 99%

“…On the other hand, the secondary cricopharyngeal muscle spasm causes propulsion of the caustic agent back to the stomach. This "seesaw" motion of the caustic agent aggravates both the esophageal and gastric burn (6,8). In severe cases, mediastinitis and peritonitis may be observed due to perforation and necrosis in the early stage.…”

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confidence: 99%