Early and Late Term Management in Caustic Ingestion in Children: A 16-year Experience

Abstract

Accidental corrosive ingestion is one of the common problems causing serious esophageal strictures in children. The acute phase treatment has a great effect on stricture development. In this study we aim to present our experience in the management of caustic ingestion, particularly during the acute phase. From January 1990 to January 2005, 296 children were admitted to our clinic with caustic ingestion. Ninety-one patients who received dilatation treatment due to esophageal strictures constituted the present study group. Forty-three of them were admitted to our centre immediately after caustic ingestion (Group A) whereas 48 of them received some kind of treatment in other hospitals and were referred us with the diagnosis of stricture 6 to 12 weeks after ingestion (Group B). In the acute phase, the patients were given nothing orally until esophagoscopy was performed in the first 24-48 hours. The patients with grades 2b and 3 lesions underwent a week of esophageal rest by using a nasogastric tube. IV fluids and broad-spectrum antibiotics with a single-dose steroid were given. IV ranitidine was also added to the medical treatment. If there were stricture formations on barium meal after 3 weeks, these patients underwent esophageal dilatation programmes. The response rates to dilatation treatment were higher in group A. In addition, increased perforation rates were observed in group B. Sixty per cent of patients in group A but none of the patients in group B have recovered in the first year. In conclusion, after caustic ingestion, esophageal rest combined with supporting treatment seems to provide a good success rate with respect to prevention of stricture development and other troublesome complications.

Difficultés de prise en charge de la sténose caustique œsophagienne chez l’enfant (série de 10 cas)

“…Les dilatations endoscopiques ont prouvé leur efficacité chez les patients consultant dans les premières 48 heures dans de nombreuses séries avec un taux de succès variant entre 27 % et 100 % selon le degré de la sténose. Pour les patients consultant six à 12 semaines après l'ingestion, des complications plus graves à type de perforation surviennent dans 0,47 % à 32 % des cas [20][21][22][23][24]. Dans notre série, pour les patients consultant dans un délai de moins de 48 heures, 75 % ont eu une rémission complète.…”

Long-term management of corrosive esophageal stricture with balloon dilation in children

“…The rate of stricture formation is reported to be between 2% and 63% in different series with caustic ingestion [4][5][6]. Although bougienage traditionally has been used in dilation of caustic esophageal stricture, there are few articles, with limited number of patients, focused on endoscopic or fluoroscopically guided balloon dilation in children [1,[7][8][9]. The purpose of this study is to evaluate the long-term clinical results of balloon dilation in the treatment of caustic esophageal stricture in children.…”

“…The most common cause of benign esophageal stricture is ingestion of caustic substance [1][2][3]. It is still an important social and medical problem in developing countries.…”

Factors Affecting the Prevalence of Gastro-oesophageal Reflux in Childhood Corrosive Oesophageal Strictures

“…The most important complication of oesophageal injury related with corrosive ingestion is CES which occurs in 25-65% of patients (1,2). The success rate of the standard oesophageal dilatation treatment is reported to be approximately 50-70%, but there is some variability between series (1-4).…”