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Singh AK, Gunjan D, Dash NR, Poddar U, Gupta P, Jain AK, Lahoti D, Nayer J, Goenka M, Philip M, Chadda R, Singh RK, Appasani S, Zargar SA, Broor SL, Nijhawan S, Shukla S, Gupta V, Kate V, Makharia G, Kochhar R. Short-term and long-term management of caustic-induced gastrointestinal injury: An evidence-based practice guidelines. Indian J Gastroenterol 2025:10.1007/s12664-024-01692-1. [PMID: 39982600 DOI: 10.1007/s12664-024-01692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 09/15/2024] [Indexed: 02/22/2025]
Abstract
The Indian Society of Gastroenterology has developed an evidence-based practice guideline for the management of caustic ingestion-related gastrointestinal (GI) injuries. A modified Delphi process was used to arrive at this consensus containing 41 statements. These statements were generated after two rounds of electronic voting, one round of physical meeting, and extensive review of the available literature. The exact prevalence of caustic injury and ingestion in developing countries is not known, though it appears to be of significant magnitude to pose a public health problem. The extent and severity of this preventable injury to the GI tract determine the short and long-term outcomes. Esophagogastroduodenoscopy is the preferred initial approach for the evaluation of injury and contrast-enhanced computed tomography is reserved only for specific situations. Low-grade injuries (Zargar grade ≤ 2a) have shown better outcomes with early oral feeding and discharge from hospital. However, patients with high-grade injury (Zargar grade ≥ 2b) require hospitalization as they are at a higher risk for both short and long-term complications, including luminal narrowing. These strictures can be managed endoscopically or surgically depending on the anatomy and extent of stricture, expertise available and patients' preferences. Nutritional support all along is crucial for all these patients until nutritional autonomy is established.
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Affiliation(s)
- Anupam Kumar Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Deepak Gunjan
- Department of Gastroenterology and HNU, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Nihar Ranjan Dash
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ajay Kumar Jain
- Department of Gastroenterology, Choithram Hospital and Research Center, Indore, 452 014, India
| | - Deepak Lahoti
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, New Delhi, 110 017, India
| | - Jamshed Nayer
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Mahesh Goenka
- Institute of Gastrosciences and Liver Transplant, Apollo Multispeciality Hospitals, Kolkata, 700 054, India
| | | | - Rakesh Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Rajneesh Kumar Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Sreekanth Appasani
- Department of Gastroenterology and Hepatology, Krishna Institute of Medical Sciences, Secunderabad, 500 003, India
| | - Showkat Ali Zargar
- Department of Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Sohan Lal Broor
- Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospitals, New Delhi, 110 076, India
| | - Sandeep Nijhawan
- Department of Gastroenterology and Hepatology, Sawai Man Singh Medical College, Jaipur, 302 004, India
| | - Siddharth Shukla
- Department of Medicine and Gastroenterology, Base Hospital, Guwahati, 781 028, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Vikram Kate
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605 006, India
| | - Govind Makharia
- Department of Gastroenterology and HNU, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Rakesh Kochhar
- Department of Gastroenterology and Hepatology, Paras Hospital, Panchkula, 134 109, India.
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Gurlek IK, Muderrisoglu A, Er ZC, Arici A, Kupeli M. Evaluation of effects of curcumin on acute esophagitis in the corrosive esophagitis model in rats. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:6677-6683. [PMID: 38498056 PMCID: PMC11422257 DOI: 10.1007/s00210-024-03038-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024]
Abstract
Ingestion of a corrosive substance may cause corrosive esophagitis. Curcumin has anti-inflammatory and mucosal protective effects. In this study, the effects of curcumin on the acute phase of corrosive esophagitis were investigated. Twenty-seven Wistar Albino rats were divided into four groups; sham (group I), control (group II), and experiment groups (group III, 100 mg/kg curcumin; group IV, 200 mg/kg curcumin). Forty percent sodium hydroxide solution was used to erode the esophagi of rats in groups other than the sham group. Curcumin was applied to animals in the experiment groups 10 min after the corrosion. After 24 h, animals were sacrificed, and esophagus samples were collected. According to the histopathological examination, the muscularis mucosa damage was regressed from 100% in group II to 71.4% in group III and 50% in group IV. Mild level of damage and collagen deposition in the tunica muscularis regressed from 66.7% of the animals in the control group to 42.9% in group III and to none in group IV. Further, an increase in submucosal collagen was present in all samples from groups II and III, while 83.3% of samples had an increase in submucosal collagen in group IV. There was a significant difference in the histopathological total score between the control group and group IV (p=0.02). The results showed that the administration of curcumin in a dose-dependent manner can relieve the acute phase of corrosive esophagitis.
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Affiliation(s)
- Ismail K Gurlek
- Outpatient Clinic for Thoracic Surgery, Ministry of Health, Bilecik State Hospital, Bilecik, Turkey
| | - Ahmet Muderrisoglu
- Department of Pharmacology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.
| | - Zafer C Er
- Department of Cardiovascular Surgery, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Akgul Arici
- Department of Pathology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Mustafa Kupeli
- Department of Thoracic Surgery, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
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Singh AK, Reddy YR, Jena A, Appasani S, Gupta P, Sinha SK, Kochhar R. Endoscopic dilation with bougies versus balloons in caustic esophageal strictures: 17-year experience from a tertiary care center. Surg Endosc 2023; 37:8236-8244. [PMID: 37653157 DOI: 10.1007/s00464-023-10384-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/06/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Endoscopic dilation is the preferred management strategy for caustic esophageal strictures (CES). However, the differences in outcome for different dilators are not clear. We compared the outcome of CES using bougie and balloon dilators. METHODS Between January 2000 and December 2016, the following data of all the patients with CES were collected: demographic parameters, substance ingestion, number of strictures, number of dilations required to achieve ≥ 14 mm dilation, post-dilation recurrence, and total dilations. Patients were divided into two groups for the type of dilator, i.e., bougie or balloon. The two groups were compared for baseline parameter, technical success, short- and long-term clinical success, refractory strictures, recurrence rates, and major complications. RESULTS Of the 189 patients (mean age 32.17 ± 12.12 years) studied, 119 (62.9%) were males. 122 (64.5%) patients underwent bougie dilation and 67 (35.5%) received balloon dilation. Technical success (90.1% vs. 68.7%, p < 0.001), short-term clinical success (65.6% vs. 46.3%, p value 0.01), and long-term clinical success (86.9% vs. 64.2%, p < 0.01) were higher for bougie dilators compared to balloon dilators. Twenty-four (12.7%) patients developed adverse events which were similar for two groups. On multivariate analysis, use of bougie dilators (aOR 4.868, 95% CI 1.027-23.079), short-term clinical success (aOR 5.785, 95% CI 1.203-27.825), and refractory strictures (aOR 0.151, 95% CI 0.033-0.690) were independent predictors of long-term clinical success. CONCLUSION Use of bougie dilators is associated with better clinical success in patients with CES compared to balloon dilators with similar rates of adverse events.
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Affiliation(s)
- Anupam Kumar Singh
- Department of Gastroenterology, Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Yalaka Rami Reddy
- Department of Gastroenterology, STAR Hospital, Nanakramguda, Hyderabad, India
| | - Anuraag Jena
- Department of Gastroenterology, Topiwala National Medical College & BYL Nair Hospital, Mumbai, India
| | - Sreekanth Appasani
- Department of Medical Gastroenterology, KIMS Hospital, Secunderabad, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Saroj Kant Sinha
- Department of Gastroenterology, Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India.
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Sharif AF, Gameel DEGE, Abdo SAEF, Elgebally EI, Fayed MM. Evaluation of Pediatric Early Warning System and Drooling Reluctance Oropharynx Others Leukocytosis scores as prognostic tools for pediatric caustic ingestion: a two-center, cross-sectional study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:5378-5395. [PMID: 34420162 PMCID: PMC8380116 DOI: 10.1007/s11356-021-15988-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
Caustic chemicals are widely distributed in our environment. Exposure to caustic agents is a lifelong problem associated with severe tissue and mucous membrane injuries. In pediatrics, corrosive exposure is the most common cause of nonpharmaceutical exposure presenting to poison control centers. Therefore, this study evaluated the role of the Pediatric Early Warning System (PEWS) and Drooling Reluctance Oropharynx Others Leukocytosis (DROOL) scores as early in-hospital outcome predictors following corrosive ingestion. The current study was a two-center, retrospective, cross-sectional study carried out among pediatric patients diagnosed with acute caustic ingestion during the past 4 years. Most exposure occurred accidentally among boys (59.4%) living in rural areas (51.9%) of preschool age (50% were 2-4 years old). Residence, body temperature, respiratory rate, vomiting, skin and mucosal burns, retrosternal pain, respiratory distress, Oxygen (O2) saturation, Glasgow Coma Scale score, HCO3 level, total bilirubin level, anemia, leukocytosis, and presence of free peritoneal fluid were significant predictors of esophageal injuries (p < 0.05). DROOL and PEWS scoring were the most significant predictors of esophageal injuries with worthy predictive power, where odds ratio (95% confidence interval (CI)) was 1.76 (0.97-3.17) and 0.47 (0.21-0.99) for PEWS and DROOL, respectively. At a cutoff of < 6.5, the DROOL score could predict esophageal injuries excellently, with AUC = 0.931; sensitivity, 91.7%; specificity, 72.5%; and overall accuracy, 91.3%. At a cutoff of > 6.5, PEWS could significantly predict unfavorable outcomes, with AUC = 0.893; sensitivity, 94.4%; specificity, 71.9%; and overall accuracy, 89.3%. However, PEWS better predicted the need for admittance to the intensive care unit (ICU). Pediatric Early Warning System (PEWS) and Drooling Reluctance Oropharynx Others Leukocytosis (DROOL) are potentially useful accurate scorings that could predict the esophageal injuries and ICU admission following corrosive ingestion in pediatrics.
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Affiliation(s)
- Asmaa Fady Sharif
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dina El Gameel El Gameel
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Poison Control Center, Aseer, Saudi Arabia
| | - Sanaa Abd El-Fatah Abdo
- Public Health and Community Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Elsayed Ibrahim Elgebally
- Department of Pediatric, Menoufia University, Shebeen Al-kom, Egypt
- Pediatric Department, Saudi German Hospital, Aseer, Saudi Arabia
| | - Manar Maher Fayed
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
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Sarma MS, Tripathi PR, Arora S. Corrosive upper gastrointestinal strictures in children: Difficulties and dilemmas. World J Clin Pediatr 2021; 10:124-136. [PMID: 34868889 PMCID: PMC8603639 DOI: 10.5409/wjcp.v10.i6.124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/30/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
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.
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Affiliation(s)
- Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Parijat Ram Tripathi
- Department of Pediatric Gastroenterology, Ankura Hospsital for Women and Children, Hyderabad 500072, Telangana, India
| | - Sachin Arora
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
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El-Asmar KM, Allam AM. Predictors of successful endoscopic management of caustic esophageal strictures in children: When to stop the dilatations? J Pediatr Surg 2021; 56:1596-1599. [PMID: 32943196 DOI: 10.1016/j.jpedsurg.2020.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/06/2020] [Accepted: 08/16/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Caustic esophageal strictures are mainly managed by endoscopic dilatations. Cases that do not respond to the dilatations eventually require an esophageal replacement. The aim of our study was to identify factors that could allow us to predict if the dilatations will be successful or not. METHODS We retrospectively reviewed the chart of 100 patients with caustic esophageal injuries treated at our center between 2012 and 2019. Collected data included age, gender, type of caustic substance, duration of the dilatations, length and extent of the strictures, number and time interval between dilatations, presence of gastroesophageal reflux, occurrence of esophageal perforation, and outcome of the dilatation program. RESULTS The patient ages ranged from 1 to 8 years old. The overall success rate was 98.2% for patients with short strictures and 81.8% for patients with long strictures (>3 cm). A long stricture, a pharyngeal extension of the stricture, the occurrence of an esophageal perforation, and the presence of gastroesophageal reflux were strong predictors of the failure of the dilatation program. The median treatment time for the patients to achieve a cure was 5 months in cases of short strictures and 17 months in cases of long strictures. Within the subgroup of patients with long strictures, a dysphagia-free period within the first year of management of 8 weeks was associated with the success of the dilatation program. CONCLUSION A length of more than 3 cm, pharyngeal involvement, the occurrence of esophageal perforation, and the presence of gastroesophageal reflux are predictors of failure of dilatations for the management of caustic esophageal strictures. A dysphagia-free period of 8 weeks or more within the first year of dilatations is considered a predictor of success of dilatations in patients with long strictures. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
| | - Ayman M Allam
- Pediatric Surgery Department, Ain Shams University, Cairo, Egypt
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Current practices in the management of corrosive ingestion in children: A questionnaire-based survey and recommendations. Indian J Gastroenterol 2021; 40:316-325. [PMID: 33991312 DOI: 10.1007/s12664-021-01153-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/18/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Corrosive ingestion causes significant morbidity in children with no standard guidelines regarding management. This survey aimed to understand practices adopted by gastroenterologists, identify lacunae in evaluation and management and suggest a practical algorithm. METHODS Indian gastroenterologists participated in an online survey (65 questions) on managing corrosive ingestion. When ≥ 50% of respondents agreed on a management option, it was considered as 'agreement'. RESULTS Ninety-eight gastroenterologists (72 pediatric) who had managed a total of ~ 2600 corrosive ingestions in the last 5 years responded. The commonest age group affected was 2-5 years (61%). Majority of ingestion was accidental (89%) with 80% due to improper corrosive storage. Ingestion of alkali and acid was equally common (alkali 41%, acid 39%, unknown 20%). History of inducing-vomiting after ingestion by community physicians was present in 57%. There was an agreement on 77% of questions. The respondents agreed on endoscopy (70%) and chest X-ray (67%) in all, irrespective of symptoms. Endoscopy was considered safe on days 1-5 after ingestion (91%) and relatively contraindicated thereafter. The consensus was to use acid suppression, always (59%); steroids, never (68%) and antibiotics, if indicated (59%). Feeding was based on endoscopic findings: oral in mild injuries and nasogastric (NG) in others. Eighty percent placed a NG tube under endoscopic guidance. Stricture dilatation was considered safe after 4 weeks of ingestion. Agreement on duration of acid suppression and stricture management (dilatation protocol and refractory strictures) was lacking. CONCLUSION Corrosive ingestion mostly affects 2-5-year olds and is accidental in majority. It can be potentially prevented by proper storage and labelling of corrosives. An algorithm for management is proposed.
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Abstract
Corrosive (caustic) material ingestion remains a major health issue, particularly in developing countries. The management strategy after corrosive ingestion should be planned according to the signs and symptoms. The management of corrosive ingestion based on endoscopic grading, nothing by mouth, and barium studies should be abandoned. With the new management protocol, esophageal stricture can be predicted with high accuracy using the simple new prognostic DROOL score (≤ 4) rather than endoscopic grading, reduced by immediate oral feeding as soon as the patient can swallow saliva instead of nothing by mouth, diagnosed earlier (10-14 days) by fluoro-endoscopic balloon-assisted esophageal examination for patients with persistent dysphagia instead of relying on a barium study (≥ 21 days), and adequately treated by initiating balloon dilation earlier during the same anesthesia procedure. Fluoroscopically guided balloon dilatation with large balloons (18-20 mm) seems to be safe, with a low frequency of complications and a high success rate. If dilatation fails after a few months, esophagectomy and replacement surgery using the stomach should be considered. The increased risk of developing esophageal carcinoma after ingestion of corrosive substances should be kept in mind.
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Affiliation(s)
- Ibrahim Uygun
- Department of Pediatric Surgery, Faculty of Medicine, Kutahya Health Sciences University, Evliya Celebi Training and Research Hospital, Merkez, 43040, Kutahya, Turkey.
| | - Salih Bayram
- Clinic of Pediatric Surgery, Artvin Government Hospital, Artvin, Turkey
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Okugbo SU, Anyanhun GA, Efobi CA, Okugbo OT. Presentation and management outcome of childhood corrosive oesophageal injury in Benin City. Afr J Paediatr Surg 2020; 17:74-78. [PMID: 33342838 PMCID: PMC8051635 DOI: 10.4103/ajps.ajps_90_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Corrosive ingestion in children occurs usually at home and frequently results in debilitating strictures. Prevention and early intervention programs are very important for good outcomes. AIMS AND OBJECTIVES This study aims at examining the immediate causative factors and problems of this subset of patients with a special focus on treatment and outcome. This study was to audit the management of patients in the paediatric age group who presented for treatment with history and sequelae of corrosive ingestion seen by the cardiothoracic unit of the University of Benin Teaching Hospital from January 2005 till December 2018. MATERIALS AND METHODS This is a 14year retrospective study of patients that presented with oesophageal burn injuries from ingestion of corrosive agents to the Cardiothoracic Unit at the University of Benin Teaching Hospital between January 2005 and December 2018. Essentially the first 5years were retrospectively included but the subsequent years were prospective. All available medical data on these patients were retrieved and studied for epidemiological, clinical and operative procedures and outcome. RESULTS A total of 49 patients were seen and admitted during the period under review. Male (29) : Female (20) ratio was 1:1.4 Mean age was 4.7±4.8 years with a range of 1-16years, The males presented earlier and had worse strictures as well as more surgical procedures. Caustic soda preparations ingested more (93.9%), all ingestions were within the household setting, and all had first aid given by way of oral palm oil. Only two (4.1%) ingested acids with only one flat battery ingestion. 45.5% of the patients had dilatation only and of these 50% recovered after 3 sessions and required no more sessions. A further 50% were lost to follow up. 38.8% had oesophageal replacement with colon following oesophagectomy. CONCLUSION In conclusion, corrosive oesophageal stricture is a debilitating disease in children and affects males more, but it is treatable by multiple dilatations and oesophageal replacement with colon. Prevention should be actively pursued as well as early intervention.
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Affiliation(s)
- Stanley U Okugbo
- Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
| | - G A Anyanhun
- Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
| | - C A Efobi
- Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
| | - O T Okugbo
- Department of Basic Science, Benson Idahosa University, Benin City, Nigeria
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Niedzielski A, Schwartz SG, Partycka-Pietrzyk K, Mielnik-Niedzielska G. Caustic Agents Ingestion in Children: A 51-Year Retrospective Cohort Study. EAR, NOSE & THROAT JOURNAL 2019; 99:52-57. [PMID: 30995860 DOI: 10.1177/0145561319843109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Children experience serious gastrointestinal tract injuries due to consumption of caustic agents more often than adults. The aim of the study was to analyze diagnostic methods and treatment of children with esophageal burns according to the degree of the injury. METHODS Our one-center population-based retrospective cohort study included 150 children admitted between 1967 and 2018 to Clinic of Pediatric Otolaryngology, Phoniatrics and Audiology of University Children's Hospital in Lublin, Poland, due to the chemical burn of the mouth, throat, larynx, and esophagus. Each patient underwent a thorough laryngological examination and endoscopy to assess the place and degree of injury. RESULTS Of 150 patients, 65.3% were male and 34.7% female. The median age was 4 years and 3 months. Salivation, dysphagia, burning sensation, edema, and whitish coating on the oral mucosa, palate, and throat were the most common clinical symptoms. In addition, dyspnea and chest pain were observed in 30% of patients. Esophagus endoscopy results were: Zargar grade I burn (84.7%), grade IIA (8%), grade IIB (2.6%), grade III (0%), and grade 0 (4.7%). Treatment included antibiotics, proton pump inhibitors, analgesics, and intravenous fluid therapy. Late sequelae (scarred esophageal strictures) developed in 20 (13.3%) patients. CONCLUSIONS Accidental intake of caustic agents is observed in young children, especially younger than the age of 5. Early esophagus endoscopy should be performed in all patients to assess the grade of injury, plan initial treatment, and predict the risk of developing complications. Early diagnosis and immediate pharmacological treatment reduce the number of late sequelae.
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Affiliation(s)
- Artur Niedzielski
- Independent Otoneurological Laboratory, Medical University of Lublin, Lublin, Poland.,Clinic of Pediatric Otolaryngology, Center of Postgraduate Medical Education (CMKP), Warsaw, Poland
| | - Sylwia Greta Schwartz
- Independent Otoneurological Laboratory, Medical University of Lublin, Lublin, Poland.,Clinic of Pediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin, Lublin, Poland
| | - Kornela Partycka-Pietrzyk
- Clinic of Pediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin, Lublin, Poland
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Abstract
OBJECTIVES Dysphagia is a common consequence of pediatric ingestion injury, yet there is a lack of data relating to recommencement of oral (per os; PO) intake or use of feeding therapy. We describe patterns of early PO intake, and referral to speech-language pathology (SLP) for feeding therapy, during the acute admission of a pediatric cohort postchemical or button battery ingestion injury. METHODS Retrospective chart review of pediatric ingestion injuries admitted to a quaternary hospital from 2008 to 2013. Clinical parameters, PO intake progression, and nature of referrals for feeding therapy during the acute admission were examined. RESULTS Fifty-one children (26 boys; mean age: 31.5, range 4-170 months) were identified (75% with grade II or III mucosal injuries), of whom 31 (60%) had impaired PO intake. Of these, 5 recommenced premorbid PO intake during admission. At discharge, 16 remained on modified PO intake, and 10 remained nil PO. Eight (26%) were referred to SLP for feeding therapy during acute admission, or within 4 months of discharge. Feeding therapy-referred children were more likely to have pediatric intensive care admission (PICU) (100% vs 26%), and longer hospital admission (36.1 vs 9.3 days for those not referred). CONCLUSIONS More than half of the cohort had impaired PO intake, and one-third were nil PO at time of discharge. Referrals for feeding therapy were limited. Our findings may provide some guidance for clinicians, patients, and their families regarding possible PO intake recovery patterns, as well as provide background for evaluating the potential for feeding therapy and SLP involvement within this population.
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Karaman İ, Koç O, Karaman A, Erdoğan D, Çavuşoğlu YH, Afşarlar ÇE, Yilmaz E, Ertürk A, Balci Ö, Özgüner IF. Evaluation of 968 children with corrosive substance ingestion. Indian J Crit Care Med 2016; 19:714-8. [PMID: 26813230 PMCID: PMC4711203 DOI: 10.4103/0972-5229.171377] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background and Aims: The aim of the study was to evaluate the etiology, treatment, and prognosis in children who had presented at our clinic with corrosive substance ingestion and comparison of our results with the literature. Materials and Methods: The patients were put on nil by mouth and broad-spectrum antibiotics were administered. Oral fluids were started for patients whose intraoral lesions resolved and who could swallow their saliva. Steroids were not given, a nasogastric catheter was not placed, and early endoscopy was not used. Results: A total of 968 children presented at our clinic for corrosive substance ingestion during the 22-year period. The stricture development rate was 13.5%. Alkali substance ingestion caused a stricture development rate of 23%. A total of 54 patients required 1–52 sessions (mean 15 ±12) of dilatation. Conclusion: We do not perform early endoscopy, administer steroids, or place a nasogastric catheter at our clinic for patients who had ingested a corrosive substance. This approach has provided results similar to other series. We feel that determining the burn with early esophagoscopy when factors that prevent or decrease the development of corrosive strictures will be very important.
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Affiliation(s)
- İbrahim Karaman
- Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Orhan Koç
- Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Ayşe Karaman
- Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Derya Erdoğan
- Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | | | | | - Engin Yilmaz
- Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Ahmet Ertürk
- Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Özlem Balci
- Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Ismet Faruk Özgüner
- Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
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Uygun I. Caustic oesophagitis in children: prevalence, the corrosive agents involved, and management from primary care through to surgery. Curr Opin Otolaryngol Head Neck Surg 2015; 23:423-432. [PMID: 26371603 DOI: 10.1097/moo.0000000000000198] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Caustic substance ingestion (CSI) remains a major health issue, particularly in developing countries, where laws are not effectively enforced. This review offers a thorough analysis of the current epidemiology, clinical features, management, treatment, and long-term complications of CSI in children. RECENT FINDINGS Strong alkalis sold in liquid and granular forms, particularly crystalline grease cleaners (concentrated sodium hydroxide), are the principal causes of severe oesophageal damage. Currently, early endoscopy to assess the gastro-oesophageal mucosa is not considered necessary for all CSI cases. Oesophageal stricture is a major complication developing after CSI, and should be diagnosed and treated earlier, 10-14 days after CSI via commencement of a dilation program. Fluoroscopically guided oesophageal balloon dilatation seems to be safe, with a low frequency of complications and a high success rate. However, it should commence earlier than is currently the case, and should be performed gently, using balloons of gradually increasing diameter. If dilation fails after a few months, oesophageal replacement surgery should be performed. SUMMARY Unfortunately, neither dilatation treatment nor oesophageal bypass surgery can prevent the development of oesophageal carcinoma, the incidence of which is high after CSI. The continuing unacceptably high incidence of CSI accidents would be reduced if corrosive materials were sold in their original childproof containers, highlighting the need for preventive and adult education programmes.
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Affiliation(s)
- Ibrahim Uygun
- Department of Paediatric Surgery, Medical Faculty of Dicle University, Sur, Diyarbakir, Turkey
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Kluger Y, Ishay OB, Sartelli M, Katz A, Ansaloni L, Gomez CA, Biffl W, Catena F, Fraga GP, Di Saverio S, Goran A, Ghnnam W, Kashuk J, Leppäniemi A, Marwah S, Moore EE, Bala M, Massalou D, Mircea C, Bonavina L. Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion. World J Emerg Surg 2015; 10:48. [PMID: 26478740 PMCID: PMC4609064 DOI: 10.1186/s13017-015-0043-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/09/2015] [Indexed: 12/15/2022] Open
Abstract
Caustic material ingestion injuries (CMI) are uncommon. Only 5,000 cases are reported in the United States each year and most acute care healthcare facilities admit only a few cases annually. Accordingly, no single institution can claim extensive experience, and management protocols are most probably based on either expert opinion or literature reports. In this study, we will attempt to review opinions and practices of representatives of the board members of the World Society of Emergency Surgery and compare them to the current literature.
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Affiliation(s)
- Yoram Kluger
- />Rambam Health Care Center, POB 9602, Haifa, 31096 Israel
| | - Ofir Ben Ishay
- />Rambam Health Care Center, POB 9602, Haifa, 31096 Israel
| | | | - Amit Katz
- />Rambam Health Care Center, POB 9602, Haifa, 31096 Israel
| | | | - Carlos Augusto Gomez
- />Hospital Universitário Therezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Universidade Federal de Juiz de Fora (UFJF), Minas Gerais Jiiz de Fora, Brazil
| | - Walter Biffl
- />Department of Surgery, University of Florida, Gainesville, Florida USA
| | | | - Gustavo P. Fraga
- />Faculdade de Ciências Médicas (FCM), Unicamp Campinas, Jiiz de Fora, Brazil
| | | | - Augustin Goran
- />Department of Surgery, University Hospital Center, Zagreb, Croatia
| | - Wagih Ghnnam
- />Mansoura Faculty of Medicine, Mansoura University Egypt, Mansoura, Egypt
| | - Jeffry Kashuk
- />Assia Medical Group, Assuta Medical Centers, Tel Aviv, Israel
| | | | - Sanjay Marwah
- />Department of Surgery, Post-graduate Institute of Medical Sciences, Rohtak, India
| | - Ernest E. Moore
- />Department of Surgery, Denver Health Medical Center, Denver, USA
| | - Miklosh Bala
- />Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Damien Massalou
- />Hôpital St Roch 5, Université Nice Sophia-Antipolis, Nice, France
| | - Chirica Mircea
- />Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Université Paris, Paris, France
| | - Luigi Bonavina
- />Policlinico San Donato, University of Milan School of Medicine, Milan, Italy
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Abstract
PURPOSE OF REVIEW This review will focus on therapeutic considerations and recent advances in treatment of caustic ingestion injuries. RECENT FINDINGS A retrospective study suggests that it may be safe to advance the endoscope beyond the first circumferential burn to allow for a more complete assessment of extent of injury. A randomized controlled prospective study suggested that a 3-day course of high-dose methylprednisolone might reduce the occurrence of esophageal stricture formation. Balloon dilatation has been shown to be as effective as other bougienage techniques with lower risk of perforations. Recent studies indicate that esophageal dilatation can be safely performed as early as 5-15 days after initial ingestion and may decrease risk for long-term stricture formation. The use of adjunctive treatment, such as topical mitomycin C and esophageal stents, shows promise in reducing the reoccurrence of stricture formation after dilatation. SUMMARY Caustic ingestion remains a significant problem in children, despite continued efforts to educate the public about ways to avoid this preventable accident. Because there are few good quality therapeutic trials in children, many of the current recommendations regarding treatment are based on expert opinion. Large, prospective, multicenter, controlled treatment trials are needed to identify the best protocols to prevent serious complications.
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Bonavina L, Chirica M, Skrobic O, Kluger Y, Andreollo NA, Contini S, Simic A, Ansaloni L, Catena F, Fraga GP, Locatelli C, Chiara O, Kashuk J, Coccolini F, Macchitella Y, Mutignani M, Cutrone C, Poli MD, Valetti T, Asti E, Kelly M, Pesko P. Foregut caustic injuries: results of the world society of emergency surgery consensus conference. World J Emerg Surg 2015; 10:44. [PMID: 26413146 PMCID: PMC4583744 DOI: 10.1186/s13017-015-0039-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/15/2015] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Lesions of the upper digestive tract due to ingestion of caustic agents still represent a major medical and surgical emergency worldwide. The work-up of these patients is poorly defined and no clear therapeutic guidelines are available. PURPOSE OF THE STUDY The aim of this study was to provide an evidence-based international consensus on primary and secondary prevention, diagnosis, staging, and treatment of this life-threatening and potentially disabling condition. METHODS An extensive literature search was performed by an international panel of experts under the auspices of the World Society of Emergency Surgery (WSES). The level of evidence of the screened publications was graded using the Oxford 2011 criteria. The level of evidence of the literature and the main topics regarding foregut caustic injuries were discussed during a dedicated meeting in Milan, Italy (April 2015), and during the 3rd Annual Congress of the World Society of Emergency Surgery in Jerusalem, Israel (July 2015). RESULTS One-hundred-forty-seven full papers which addressed the relevant clinical questions of the research were admitted to the consensus conference. There was an unanimous consensus on the fact that the current literature on foregut caustic injuries lacks homogeneous classification systems and prospective methodology. Moreover, the non-standardized definition of technical and clinical success precludes any accurate comparison of therapeutic modalities. Key recommendations and algorithms based on expert opinions, retrospective studies and literature reviews were proposed and approved during the final consensus conference. The clinical practice guidelines resulting from the consensus conference were approved by the WSES council. CONCLUSIONS The recommendations emerging from this consensus conference, although based on a low level of evidence, have important clinical implications. A world registry of foregut caustic injuries could be useful to collect a homogeneous data-base for prospective clinical studies that may help improving the current clinical practice guidelines.
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Affiliation(s)
- Luigi Bonavina
- />Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy
| | - Mircea Chirica
- />Department of Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Ognjan Skrobic
- />Department of Surgery, University of Belgrade, Belgrade, Serbia
| | - Yoram Kluger
- />Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Aleksander Simic
- />Department of Surgery, University of Belgrade, Belgrade, Serbia
| | - Luca Ansaloni
- />General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fausto Catena
- />Emergency Surgery Department, Maggiore Parma Hospital, Parma, Italy
| | - Gustavo P. Fraga
- />Department of Surgery, University of Campinas, Campinas, Brasil
| | - Carlo Locatelli
- />Institute of Toxicology, University of Pavia, Pavia, Italy
| | | | - Jeffry Kashuk
- />Department of Surgery, University of Jerusalem, Jerusalem Rehovot, Israel
| | | | - Yuri Macchitella
- />Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy
| | | | - Cesare Cutrone
- />Department of Otolaryngology, Azienda Ospedaliera, Padova, Italy
| | - Marco Dei Poli
- />Intensive Care Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Tino Valetti
- />Department of Anesthesiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Emanuele Asti
- />Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy
| | - Michael Kelly
- />Department of Surgery, Wagga Wagga Hospital, Wagga Wagga, Australia
| | - Predrag Pesko
- />Department of Surgery, University of Belgrade, Belgrade, Serbia
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Losada M M, Rubio M M, Blanca G JA, Pérez A C. [Ingestion of caustic substances in children: 3 years of experience]. ACTA ACUST UNITED AC 2015; 86:189-93. [PMID: 26363860 DOI: 10.1016/j.rchipe.2015.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 03/10/2015] [Indexed: 01/21/2023]
Abstract
INTRODUCTION There is no clear consensus on the management of accidental ingestion of caustic substances in paediatrics. The aim of this study was to determine the profile of the paediatric population treated due to caustic ingestion in a Healthcare Centre. PATIENTS AND METHOD A descriptive study was conducted on patients treated for the ingestion of caustic substances in our hospital during the period 2008-2011. RESULTS A total of 12 patients were treated, with a mean age of 3.8 years (1-13 years), with the majority males (58.8%). An alkaline product was ingested by 58.3%, and an acid by 41.6%. The majority (58.3%) did not refer to symptoms and the remainder referred to vomiting (33.3%), odynophagia (16.6%), haematemesis (8.3%), hyper-salivation (8.3%) and shortness of breath (8.3%). Oral cavity lesions were observed in 75% of cases. All, except one, were accidental. An endoscopy was performed on all of them (100%) between 12 and 24hours post-ingestion, with pathological findings in 41.6%. In the group that ingested an alkali, 2 (16.6%) patients had lesions, one a grade 2B and one a grade 3 oesophagitis. In the acid ingestion group, 4 (33.3%) patients had lesions; one grade 1-2A oesophagitis, two acute non-erosive gastritis, and one acute haemorrhagic gastritis. A follow-up endoscopy was performed depending on the previous endoscopic findings. Only two patients presented with complications. CONCLUSIONS Emphasis is placed on the endoscopic evaluation in the first 24hours of deliberate asymptomatic ingestions, as well as a strict follow-up in those that ingested acids, due to delayed associated lesions.
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Affiliation(s)
- María Losada M
- Unidad de Gestión Clínica de Pediatría, Hospital Universitario Virgen Macarena, Sevilla, España
| | - María Rubio M
- Sección de Digestivo y Nutrición Infantil, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Infantil Virgen del Rocío, Sevilla, España.
| | - Jose Antonio Blanca G
- Unidad de Gestión Clínica de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Cristina Pérez A
- Unidad de Gestión Clínica de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, España
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Song HK, Shim KN, Yun HW, Tae CH, Kim SE, Jung HK, Jung SA, Yoo K. [Caustic injury of upper gastrointestinal tract: 20 year experience at a tertiary referral center]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2015; 65:12-20. [PMID: 25603849 DOI: 10.4166/kjg.2015.65.1.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND/AIMS Caustic ingestion can cause severe injury to upper gastrointestinal tract. There were few studies about clinical characteristics and treatments of caustic injury in Korea. We investigated the changes in clinical features of caustic injury over the past 20 years including pattern of endoscopic mucosal injury and treatment modality. METHODS This study was a retrospective review of medical records from patients with caustic injury from September 1993 through December 2012. Patients were classified into two groups based on the year when caustic ingestion occurred: patients who visited the hospital from 1993 to 2002 (early group) and patients who visited the hospital from 2003 to 2012 (late group). RESULTS A total 140 patients were included (early group [n=50] vs. late group [n=90]). Annual number of caustic ingestions did not show decreasing tendency over the past 20 years. Alkali ingestion increased (20.0% vs. 65.6%, p<0.001) and cases with more than grade 2b of esophageal mucosal injury decreased (41.3% vs. 20.7%, p=0.012) in late group. There were no differences between two groups in sex, age, proportion of accidental ingestion, and systemic/gastrointestinal complications. Use of gastric lavage (p<0.01) and broad spectrum antibiotics (p=0.03) decreased in late group. However, there was no difference in use of steroid between two groups. CONCLUSIONS In this study, overall caustic ingestion did not decrease and ingestion of alkali agents increased over the past 20 years. Tighter legislation on caustic agents is required and we need to be alert to the best management of caustic injury.
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Affiliation(s)
- Hye Kyung Song
- Department of Health Promotion Medicine, Ewha Womans University Medical Center Mokdong Hospital, Seoul, Korea
| | - Ki Nam Shim
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hye Won Yun
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Seong Eun Kim
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hye Kyung Jung
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung Ae Jung
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kwon Yoo
- Department of Health Promotion Medicine, Ewha Womans University Medical Center Mokdong Hospital, Seoul, Korea
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Follent AM, Rumbach AF, Ward EC, Dodrill P, Clayton NA. Speech-language pathology services in Australian and New Zealand pediatric burn units and chemical ingestion injury. SPEECH, LANGUAGE AND HEARING 2014. [DOI: 10.1179/2050572814y.0000000057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Bonnici KS, Wood DM, Dargan PI. Should computerised tomography replace endoscopy in the evaluation of symptomatic ingestion of corrosive substances? Clin Toxicol (Phila) 2014; 52:911-25. [PMID: 25224219 DOI: 10.3109/15563650.2014.957310] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Corrosive ingestions are common, although most ingestions do not result in clinically significant effects. Limited guidance is available on the role of endoscopy and/or computerised tomography (CT) in the investigation of individuals with corrosive ingestion, and the present data regarding predictors of poor outcome are confusing. Furthermore, whilst there are many case series describing the use of endoscopy in corrosive ingestions, no clear ideal time frame has been established as to when it should be undertaken. More recently, CT has been used to grade injuries, but there are few studies on its role in managing corrosive injuries, and those studies that have been reported are conflicting in their results. METHODS A Medline search was performed with the terms 'Caustic ingestion' and 'Corrosive ingestion' and a second search by adding the words 'Endoscopy', 'CT', and 'Computerised tomography' as a subject term or keyword. These searches revealed a total of 277 reviews and papers, of which 33 original papers were relevant for analysis. Three further papers were identified during the analysis of these papers and a PubMed search of the same terms added one further paper, bringing the total to 37. There have been no prospective, randomised controlled trials directly comparing endoscopy and CT. Only two retrospective studies compared the use of CT and that of endoscopy. Thirty-five studies examined whether an endoscopy is always needed, and if so, within what time frame this should be done: CT or endoscopy? A review of these studies suggests that the data regarding the use of CT in these circumstances are not yet of sufficient weight to replace endoscopy as the first-line investigation in corrosive ingestion-related injury. Who needs investigation after corrosive ingestion? We believe that signs and symptoms indicate the likelihood of clinically significant injury in adults. Specifically, any evidence of oropharyngeal burns, drooling, vomiting, pain or dysphagia clearly indicates the need for an endoscopy. In children, it appears that an even greater degree of caution is needed. How soon after ingestion should investigation be performed? For whom an endoscopy is required, it is prudent to enable surgery and other specifics regarding management of corrosives to be decided quickly (< 12 h). There are many incidences where endoscopy has been done safely beyond 48 h although this is not needed frequently. Management recommendations Asymptomatic patients, particularly adults with a normal clinical examination and who can eat and drink normally, can be discharged safely without endoscopy. Endoscopy is preferred over CT in the assessment of risk in symptomatic patients with corrosive ingestion. If patients have any oropharyngeal injury and in particular symptoms of drooling, vomiting, dysphagia or pain (retrosternal or otherwise), the risk of having a high-grade injury is higher, and urgent endoscopy should be performed to grade the injury and determine whether surgical intervention is required. Patients who have non-specific symptoms, such as cough, should also undergo endoscopy, but this is less urgent. CONCLUSIONS Despite the lack of high-quality clinical trial data, the available evidence and clinical experience support the use of early endoscopy (< 12 h) in patients who are symptomatic after ingestion of a corrosive substance. We propose a clinical guideline that can be used to help plan management of corrosives.
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Affiliation(s)
- K S Bonnici
- Department of Acute Medicine, Chelsea & Westminster Hospital NHS Trust , London , UK
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Iskit SH, Ozçelik Z, Alkan M, Türker S, Zorludemir U. Factors Affecting the Prevalence of Gastro-oesophageal Reflux in Childhood Corrosive Oesophageal Strictures. Balkan Med J 2014; 31:137-42. [PMID: 25207185 DOI: 10.5152/balkanmedj.2014.13276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 05/07/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Gastro-oesophageal reflux may accompany the corrosive oesophageal damage caused by the ingestion of corrosive substances and affect its treatment. The factors that affect the development of reflux in these cases and their effects on treatment still remain unclear. AIMS Our aim is to investigate the prevalence of gastro-oesophageal reflux in children with corrosive oesophageal strictures, the risk factors affecting this prevalence and the effects of gastro-oesophageal reflux on treatment. STUDY DESIGN Case-control study. METHODS We enrolled 52 patients with oesophageal stricture due to corrosive substance ingestion who were referred to our clinic between 2003 and 2010. Groups, which were determined according to the presence of gastro-oesophageal reflux (GER), were compared with each other in terms of clinical findings, results of examination methods, characteristics of the stricture and success of the treatment. RESULTS The total number of patients in our study was 52; 30 of them were male and 22 of them were female. The mean age of our study population was 4.2±2.88 years. Thirty-three patients had gastrooesophageal reflux (63.5%). Patients who had strictures caused by the ingestion of alkali substances were 1.6-times more likely to have reflux. There were no differences between patients with or without reflux in terms of number and localisation of strictures. Mean distance of stricture was longer in patients with reflux (3.7±1.8 cm) than in patients without (2.2±1.0 cm) (p<0.005). Only one patient among 17 who had a long stricture (≥4 cm) did not suffer from reflux. Patients with long stricture were 1.9-times more likely to have reflux. Dilatation treatment was successful in 69.6% of patients with reflux and in 78.9% of patients without. The mean treatment period was 8.41±6.1 months in patients with reflux and 8.21±8.4 months in the other group. There was no significant difference between groups in terms of frequency of dilatation and dilator diameters (p>0.05). CONCLUSION Corrosive oesophageal stricture was usually accompanied by gastro-oesophageal reflux and the length of stricture is an important risk factor. Negative effects of reflux over dilatation treatment have not yet been demonstrated in the short-term. Nevertheless, this frequent rate of reflux may eventually increase the risk of oesophagitis and Barrett's oesophagus; therefore, we suggest that these effects should be prospectively evaluated in a large number of patients and these patients should be followed-up routinely in terms of the long-term effects of reflux.
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Affiliation(s)
- Serdar H Iskit
- Department of Pediatric Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Zerrin Ozçelik
- Department of Pediatric Surgery, Numune Hospital, Adana, Turkey
| | - Murat Alkan
- Department of Pediatric Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Selcan Türker
- Department of Pediatric Surgery Unit, Şehit Kamil Hospital, Gaziantep, Turkey
| | - Unal Zorludemir
- Department of Pediatric Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
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Uygun I, Arslan MS, Aydogdu B, Okur MH, Otcu S. Fluoroscopic balloon dilatation for caustic esophageal stricture in children: an 8-year experience. J Pediatr Surg 2013; 48:2230-2234. [PMID: 24210191 DOI: 10.1016/j.jpedsurg.2013.04.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 04/05/2013] [Accepted: 04/21/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE Esophageal balloon dilatation (EBD), when performed early and correctly, can efficiently treat caustic esophageal stricture (ES). Herein, we present 8 years of experience treating caustic ES, and discuss the technique as well as the complications. METHODS We retrospectively reviewed the medical records of 38 children in whom we performed fluoroscopic EBD under general anesthesia for caustic ES between November 2004 and November 2012 in our hospitals. The patients were grouped into the early dilatation group, who began EBD earlier (mean, 15 days) after caustic ingestion, and the late dilatation group who was referred later (mean, 34 days) for EBD by other centers. The ESs were classified into short and long strictures. Balloon size was increased gradually to a sufficient diameter over consecutive sessions. Characteristics of patients and ES, details of the EBD, and treatment results were analyzed. RESULTS A total of 369 EBD sessions were successfully performed in 38 children (aged 14 months to 14 years, median 3.5 years). In six patients, EBD treatments are continuing, one patient was lost to follow up, one patient who received a stent was excluded, and three returned to their previous centers. The remaining 27 patients were treated successfully by repeated EBD treatments. Nevertheless, in the early dilatation group (n=16), EBD treatment was significantly faster and shorter than that in the late dilatation group (n=11). In addition, the short stricture treatment was also of significantly shorter duration than the long stricture treatment. Six (1.6%) esophageal perforations occurred in five patients (13.2%); all were treated conservatively. There was no mortality. CONCLUSIONS For treatment of caustic ES, fluoroscopically guided EBD is safe and has a low rate of complications as well as a 100% success rate. However, it should be begun earlier, and in children, should be performed gently with balloons of gradually increasing appropriate diameters over consecutive sessions.
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Affiliation(s)
- Ibrahim Uygun
- Department of Pediatric Surgery, Medical Faculty of Dicle University, 21280 Diyarbakir, Turkey.
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Adedeji TO, Tobih JE, Olaosun AO, Sogebi OA. Corrosive oesophageal injuries: a preventable menace. Pan Afr Med J 2013; 15:11. [PMID: 23898360 PMCID: PMC3725316 DOI: 10.11604/pamj.2013.15.11.2495] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 04/20/2013] [Indexed: 12/30/2022] Open
Abstract
Introduction Potentially catastrophic presentations and lifelong complications resulting from corrosive ingestions in humans is one of the most challenging situations encountered in clinical medical practice. This study reviewed pattern, mechanisms and associated socio-medical challenges with ingestion of corrosive agents as seen in a tertiary health institution in South-western Nigeria. Methods A retrospective review of all patients that were managed for corrosive ingestion at Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria, over a seven year period. Results A total of 28 patients M:F: 1.6:1. There were 7 children and 21 adults. Majority (78.6%) of the patients ingested alkaline substances. Accidental ingestion occurred in 28.6% while 71.4% resulted from deliberate self harm especially among adults (66.7%). Almost two thirds (64.3%) of the patients presented after 48hrs of ingestion. Patients who presented early were managed conservatively. Most patients (64.3%) who presented late had nutritional and fluid rehabilitation. Two patients died from oesophageal perforation and resulting septicaemia. Psychiatric evaluation revealed that seven adults (25%) had psychotic illness while (42.9%) of the patients developed oesophageal strictures. Short segment strictures were managed with oesophageal dilatation with good outcome while long and multiple segment strictures were referred to cardiothoracic surgeons for management. Conclusion Corrosive oesophageal injuries remain a prevalent and preventable condition in the developing countries. Preventive strategies should include regulation and packaging of corrosive substances, organization of psychiatric services, and education of the population on corrosive ingestion.
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Endoscopic management of strictures in pediatrics. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2013. [DOI: 10.1016/j.tgie.2012.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Harlak A, Yigit T, Coskun K, Ozer T, Mentes O, Gülec B, Kozak O. Surgical treatment of caustic esophageal strictures in adults. Int J Surg 2012; 11:164-168. [PMID: 23267851 DOI: 10.1016/j.ijsu.2012.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 11/28/2012] [Accepted: 12/13/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Caustic esophageal injury is a rare clinical condition in adult patients. Although dilatation, or the conservative approach, is the primary treatment method, some patients require surgical intervention. Because of the rarity of such cases, standard surgical treatment algorithms cannot be utilized. In this article, we present our surgical experience and discuss the challenges in the surgical management of corrosive injury of the esophagus in adults. METHODS A retrospective review was conducted of 28 patients who suffered from a corrosive esophageal injury between 1996 and 2011. Patient demographics, history of corrosive material ingestion, preoperative findings, treatment strategy, operative technique, postoperative course, requirements for further treatment, and the current status of the patients were investigated. RESULTS All patients underwent a transhiatal esophagectomy in addition to a gastric pull-up with a cervical esophagogastrostomy. The mean follow-up time was 62 (12-140) months. One patient developed a deep surgical infection; anastomotic stenosis was noted and treated with dilatation in 13 patients. The mean time period between the operation and the first dilatation for 12 patients was 81 (45-161) days. The mean dilatation count for the patients was 3 (1-10). CONCLUSION Although it comes with high anastomotic stenosis rates, transhiatal esophagectomy and gastric pull-up with cervical anastomosis is a safe procedure, which can be performed for the treatment of corrosive esophageal stricture.
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Affiliation(s)
- Ali Harlak
- Gülhane Military Medical Academy, Gulhane Medical School, Department of General Surgery, GATA Genel Cerrahi AD., Etlik, Ankara 06018, Turkey.
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Uygun I, Aydogdu B, Okur MH, Arayici Y, Celik Y, Ozturk H, Otcu S. Clinico-epidemiological study of caustic substance ingestion accidents in children in Anatolia: the DROOL score as a new prognostic tool. Acta Chir Belg 2012; 112:346-354. [PMID: 23175922 DOI: 10.1080/00015458.2012.11680850] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND To examine the clinico-epidemiological details of paediatric caustic substance ingestion (CSI) accidents in Turkey. To present the new DROOL Score (DS), which the authors developed based on the severity and duration of initial signs and symptoms (ISSs) to predict oesophageal stricture (OS) without endoscopy, and to present our management protocol based on immediate feeding, early detection, and oesophageal balloon dilatation (OBD) of OS with no barium study. METHODS We prospectively reviewed the records of 202 children admitted with a history of CSI within 48 hours. Patient, parent, caustic substance, and accident characteristics were noted in detail. Patients were fed as soon as they could swallow saliva. Diagnoses of OS were made earlier via timely endoscopy (mean, 10-14 days after CSI) for patients with persistent dysphagia and OBD was started earlier. ISSs and DSs were analyzed. OS treatment results were compared between early (10-14 days) and late (> or = 21 days) dilatation patients who were referred for OBD by other hospitals. RESULTS In total, 144 (71%) incidents occurred within the parents' home and 44 (22%) occurred at another individual's home. The caustic substances were frequently sold in non-original containers (68.8%). Most patients' parents had low incomes and were poorly educated. Ninety-six children had no ISSs, whereas 106 patients had ISSs. Seventeen symptomatic patients had persistent dysphagia after 10-14 days. Timely endoscopy was performed within 10-14 days for these patients only, and OS was diagnosed and successfully treated. DSs were significantly lower in patients with OS than those without (p < 0.001). A DS < or = 4 was a significant predictor of OS (100% sensitivity, 96% specificity, 85% positive and 100% negative predictive values). Results were significantly more satisfactory in early (n = 17) than in late (n = 6) dilatation patients. CONCLUSIONS Paediatric CSI accidents might decrease if caustic substances were sold in the original child-proof containers. OS can be highly predicted by a simple DS instead of endoscopic grading, and can be diagnosed earlier (10-14 days) via endoscopy only in patients with persistent dysphagia, instead of a late barium study (> or = 21 days). OBD can then also be started earlier in these patients.
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Affiliation(s)
- I Uygun
- Department of Paediatric Surgery, Dicle University, Faculty of Medicine, Diyarbakir, Turkey.
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Ekpe EE, Ette V. Morbidity and mortality of caustic ingestion in rural children: experience in a new cardiothoracic surgery unit in Nigeria. ISRN PEDIATRICS 2012; 2012:210632. [PMID: 22778986 PMCID: PMC3384939 DOI: 10.5402/2012/210632] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 04/29/2012] [Indexed: 12/17/2022]
Abstract
Background. Inspite of the fact that accidental caustic ingestion is an entirely easily preventable problem, it has however persisted in rural Nigerian communities because the commonly implicated agent which is caustic soda (sodium hydroxide, NaOH) is sold in open markets without restrictive legislations. This study aims to identify the perpetuating factors of paediatric caustic ingestion and recommend preventive measures. Method. Retrospective analysis of clinical records of our paediatric patients who presented following caustic ingestion between November 2006 and November 2010 was made for demography, socioeconomic status of parent(s), caustic substance ingested with amount (where known), circumstance of ingestion, means of oesophageal evaluation, treatment and outcome. Results. There were 16 paediatric cases of caustic ingestion during the study period with age ranging from 1 to 18 years with mode in the 1–3 years group and male : female ratio 4.3 : 1. In 100% of the cases, the caustic ingestion was accidental, while caustic soda was the agent in 93.7%, and 87.5% of the parents were into local soap and detergent production. In all patients, the oesophagus was evaluated with late barium swallow/meal and oesophagoscopy before treatment. Conclusion. Caustic ingestion among rural children in Nigeria can be prevented.
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Affiliation(s)
- E E Ekpe
- Cardiothoracic Surgery Unit, Department of Surgery, University of Uyo Teaching Hospital, PMB 1136 Uyo, Akwa Ibom, Nigeria
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Temiz A, Oguzkurt P, Ezer SS, Ince E, Hicsonmez A. Predictability of outcome of caustic ingestion by esophagogastroduodenoscopy in children. World J Gastroenterol 2012; 18:1098-103. [PMID: 22416185 PMCID: PMC3296984 DOI: 10.3748/wjg.v18.i10.1098] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 01/16/2012] [Accepted: 02/08/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the necessity of esophagogastroduodenoscopy (EGD) to predict the outcome of caustic ingestion in children.
METHODS: The study included 206 children who underwent EGD because of ingestion of caustic substances between January 2005 and August 2010. Retrospective analysis of data of the patients was performed.
RESULTS: The male/female ratio was 1.6 and mean age was 38.1 ± 28.8 mo. The caustic substances were acidic in 72 (34.9%) cases, alkaline in 56 (27.2%), liquid household bleach in 62 (30.1%), and unknown in 16 (7.8%). Fifty-seven (27.7%) patients were symptom-free. Significant clinical findings were observed in 149 (72.3%) patients. Upper gastrointestinal endoscopy findings of esophageal injury were grade 0 in 86 (41.7%) patients, grade 1 in 49 (23.8%), grade 2a in 42 (20.4%), grade 2b in 28 (13.6%), and grade 3a in 1 (0.5%) patient. 35 patients with grade 2a, 2b, and 3a injuries underwent esophageal dilation at second week of ingestion. Esophageal stricture, which necessitated a regular dilation program developed in 13 of the aforementioned 35 patients. There is no statistically significant difference in the rate of development of esophageal stricture between the patients who ingested acidic (15.3%) and alkaline (8.9%) substances (P = 0.32). Severe gastric injury was detected in 38 (18.5%) patients. The rate of development of gastric injury was significantly higher in the acidic group (14%) than in the alkaline group (2.9%) (P = 0.001). Out of 149 patients with clinical findings, 49 (32.9%) patients had no esophageal injury and 117 (78.5%) patients had no gastric lesion. Esophageal and severe gastric injuries were detected in 20 (35.1%) and 8 (14%) of patients with no clinical findings respectively. Pyloric stenosis developed in 6 patients. Pyloric obstruction improved with balloon dilation in 2 patients. Mean hospitalization time were 1.2 ± 0.5 d for grade 0 and 2.3 ± 5 d for grade 1 and 6.3 ± 6.2 d for grade 2a and 15.8 ± 18.6 d for grade 2b. It was significantly longer for patients with grade 2a and 2b injuries (P = 0.000).
CONCLUSION: Endoscopy is an effective technique for determining the presence of esophageal and gastric damage and to avoid unnecessary treatment in patients with no or mild injury.
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Contini S, Scarpignato C, Rossi A, Strada G. Features and management of esophageal corrosive lesions in children in Sierra Leone: lessons learned from 175 consecutive patients. J Pediatr Surg 2011; 46:1739-1745. [PMID: 21929983 DOI: 10.1016/j.jpedsurg.2011.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 02/12/2011] [Accepted: 03/13/2011] [Indexed: 12/17/2022]
Abstract
PURPOSE This study aims to highlight the peculiar presentation and management of children's corrosive ingestions in developing countries associated with malnutrition, delay in management, lack of technology, and sporadic follow-up. METHODS An observational study was carried out since 2005 on all children (<15 years old) admitted for caustic soda ingestion to the "Emergency" Surgical Center in Sierra Leone, either in the acute postinjury phase or for dilatation of esophageal strictures. Complications, mortality, stricture recurrence, and ability to swallow were the main outcome measures. Improvement in nutritional status (ie, gaining weight) and sustained esophageal patency were both considered reference points to successful treatment. RESULTS In 4 years (2005-2009), 175 children were admitted, 53.7% at more than 1 month after ingestion. Dilatations were carried out in 77.7%, and a gastrostomy was placed in 64%. Perforations and death rate were 4.5% and 2.8%, respectively. Sixty-two patients (35.4%) required more than 7 dilatations, whereas 15 (8.5%) were unable to maintain a satisfactory luminal diameter. Follow-up (range, 1-36 months; median, 7 months) was possible in 52.7%. Long-term success according to the aforementioned criteria was observed in only 16%. CONCLUSIONS Delayed presentations and complex strictures with repeated postdilatation recurrence are characteristics of children's corrosive ingestion in developing countries. Malnutrition is common, and gastrostomy is frequently compulsory. Esophageal patency with improvement in nutritional state is achieved only in a small percentage of patients.
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Affiliation(s)
- Sandro Contini
- Department of Surgical Sciences, University of Parma, Parma 43100, Italy.
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Foschia F, De Angelis P, Torroni F, Romeo E, Caldaro T, di Abriola GF, Pane A, Fiorenza MS, De Peppo F, Dall'Oglio L. Custom dynamic stent for esophageal strictures in children. J Pediatr Surg 2011; 46:848-53. [PMID: 21616239 DOI: 10.1016/j.jpedsurg.2011.02.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 02/11/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Esophageal stenting represents a new strategy to avoid multiple dilations owing to stenosis relapse. Our custom stent improves esophageal motility unlike the widespread self-expandable plastic esophageal stents. The aim of the study was to confirm the efficacy of treatment with silicone custom stents in esophageal stenosis (ES) in pediatric patients. METHODS A silicone stent of 7-, 9-, or 12.7-mm external diameter is built coaxially on a nasogastric tube that guarantees the correct position. The 2 ends are tailored to allow food passage between stent and esophageal wall. All patients received dexamethasone (2 mg/kg per day) for 3 days and ranitidine/proton-pump inhibitors. Study approval was obtained from our ethical board. RESULTS From 1988 to 2010, 79 patients with ES, mean age 35.4 months (3-125 months), underwent esophageal hydrostatic/Savary dilations and custom-stent placement, left in place for at least 40 days. Stenting was effective in 70 (88.6%) of 79 patients. Fifty percent of the patients with effective treatment received only one dilation for stent placement. Fourteen patients received more stents successfully. There was one stent-related major complication. CONCLUSION Our custom stent improves treatment in ES. In caustic injuries, ES stenting represents the first option. In postsurgical ES, we stent after at least 5 dilations.
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Affiliation(s)
- Francesca Foschia
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Hospital, 00165 Rome, Italy.
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Therapeutic options for management of pharyngoesophageal corrosive strictures. J Gastrointest Surg 2011; 15:566-75. [PMID: 21331658 DOI: 10.1007/s11605-011-1454-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 01/30/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Pharyngoesophageal strictures due to corrosive injury raise difficult therapeutic problems due to the site of stricture, the possible association with laryngeal injury and the presence of downstream esophageal strictures. We present here our approach to management of 51 consecutive patients with pharyngoesophageal strictures seen over a 30-year period. METHODS Patients (51) with PES were managed by one of several options depending on the individual case, viz. dilatation alone, dilatation followed by esophagocoloplasty, dilatation after cervical esophagostomy with or without an esophagocoloplasty, pectoralis major or sternocleidomastoid myocutaneous flap inlays with or without esophagocoloplasty, pharyngocoloplasty with tracheostomy, and neck exploration followed by esophagocoloplasty if a lumen was found in the cervical esophagus. RESULTS The overall results were excellent with satisfactory swallowing restored in 45 out 51 patients (88.2%). There was one death and three incidences of complications, two patients with temporary cervical salivary fistula, and one patient in whom swallowing could not be restored because of lack of suitable conduit. The mean dysphagia score was improved from a pre-operative value of 3.6 to 1.5 post-operatively. CONCLUSION In conclusion, pharyngoesophageal strictures require considerable expertise in management, and one should be aware of various options for this purpose. The choice of procedure depends on site of stricture, time of presentation after the corrosive injury, relationship of the stricture to the laryngeal inlet, status of the larynx and the airway, length of the stricture, presence or absence of a lumen distal to the stricture in the cervical esophagus, and presence or absence of strictures further downstream. With proper treatment, mortality is negligible and morbidity minimal and is usually restricted to temporary salivary fistula.
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Huang HC, Chen HC, Fang HY, Lin YC, Wu CY, Cheng CY. Lung abscess predicts the surgical outcome in patients with pleural empyema. J Cardiothorac Surg 2010; 5:88. [PMID: 20961413 PMCID: PMC2976737 DOI: 10.1186/1749-8090-5-88] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 10/20/2010] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Most cases of pleural empyema are caused by pulmonary infections, which are usually combined with pneumonia or lung abscess. The mortality of patients with pleural empyema remains high (up to 20%). It also contributes to higher hospital costs and longer hospital stays. We studied pleural empyema with combined lung abscess to determine if abscess was associated with mortality. METHODS From January 2004 to December 2006, we retrospectively reviewed 259 patients diagnosed with pleural empyema who received thoracscopic decortications of the pleura in a single medical center. We evaluated their clinical data and analyzed their chest computed tomography scans. Outcomes of pleural empyema were compared between groups with and without lung abscess. RESULTS Twenty-two pleural empyema patients had lung abscesses. Clinical data showed significantly higher incidences in the lung abscess group of pre-operative leukocytosis, need for an intensive care unit stay and mortality. CONCLUSION Patients with pleural empyema and lung abscess have higher intensive care unit admission rate, higher mortality during 30 days and overall mortality than patients with pleural empyema. The odds ratio of lung abscess is 4.685. Physician shall pay more attention on high risk patient of lung abscess for early detection and management.
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Affiliation(s)
- Hung-Che Huang
- Department of Surgery, Changhua Christian Hospital, 135 Nanshiao Street, Changhua, 500, Taiwan
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Minimally invasive management of children with caustic ingestion: less pain for patients. Pediatr Surg Int 2010; 26:251-5. [PMID: 19936762 DOI: 10.1007/s00383-009-2525-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2009] [Indexed: 12/15/2022]
Abstract
PURPOSE Management of caustic ingestion in children is still controversial. In this study, we evaluate a minimally invasive management consisting of flexible endoscopy, balloon dilatation and intralesional steroid injection in children, with a history of caustic ingestion. METHODS Between April 2002 and January 2009, 350 (206 males and 144 females) children with a history of caustic ingestion were admitted. Enteral feeding was discontinued for 24 h. Parenteral feeding was started in patients with inadequate oral intake. No patient underwent an early esophagoscopy or gastrostomy. A contrast study of upper gastrointestinal tract was performed in all patients with persistent dysphagia within 3 weeks after injury. In case of an esophageal stricture, a dilatation program was initiated. For this purpose, a flexible esophagoscopy was performed. A guidewire was placed through the narrowed segment into the stomach and a balloon dilatator was inserted with the assistance of the guidewire. Balloon dilatations were performed every 1-3 weeks. In intractable strictures, triamcinolone acetonide (TAC) was injected into the narrowed segment via flexible endoscopy. RESULTS Seventeen patients (8 males, 9 females, median 3 years old) required esophageal dilatation. All of the patients completed dilatation program with complete relief of symptoms. None of the patients required any stent application nor esophageal replacement or gastrostomy. Ten patients underwent intralesional TAC injection. No patient had an esophageal perforation or any other complication related to dilatation. In all patients, the symptoms have been alleviated completely and no further dilatation was necessary after a median of five dilatation sessions (1-19 dilatations). CONCLUSION Minimally invasive management of caustic ingestion consisting of flexible endoscopy, guidewire-assisted esophageal balloon dilatation and intralesional TAC injection without any gastrostomy or esophageal stent/placement is effective and leads to relief of dysphagia in almost all patients. This method of dilatation is also safe and iatrogenic esophageal perforation is very unlikely.
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Lee HJ, Lee JH, Seo JM, Lee SK, Choe YH. A single center experience of self-bougienage on stricture recurrence after surgery for corrosive esophageal strictures in children. Yonsei Med J 2010; 51:202-5. [PMID: 20191010 PMCID: PMC2824864 DOI: 10.3349/ymj.2010.51.2.202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 06/23/2009] [Accepted: 06/26/2009] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study was undertaken to evaluate the long-term treatment of esophageal strictures in children with corrosive esophagitis and to determine the effect of self-bougienage on recurrent strictures. MATERIALS AND METHODS We reviewed the medical records of nine children that were treated for corrosive esophageal strictures from May 2000 to May 2008. Six males and three females were included and their average age was 30 months. Six patients had ingested acids, two patents had ingested alkali, and one ingested an unknown agent. RESULTS The interval between caustic ingestion and esophageal stricture ranged from one to eight weeks. The average length of the esophageal strictures was 3.8 cm (range, 1 to 9.2 cm). Four patients had a long segment stricture (longer than 5 cm) and one patient had multiple strictures. The most common site of involvement was the upper third followed by the mid third of the esophagus. Eight patients received repeated dilatation using a balloon catheter or bougie dilator. Among the eight patients, two patients had complete resolution of symptoms and six patients required surgery. Among five patients that developed restenosis of the esophageal anastomosis site, three patients had improved symptoms after self-bougienage and two patients had improved symptoms with repeated balloon dilatation or endoscopic bougienage. There were no complications in these patients. CONCLUSION Although a small number of patients were studied, self-bougienage was safe, less invasive, and effective for the management of esophageal restenosis in patients who required frequent dilation after surgery.
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Affiliation(s)
- Hae Jeong Lee
- Department of Pediatrics, Masan Samsung Medical Center, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Jee Hyun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Meen Seo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk Koo Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yon Ho Choe
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Temiz A, Oguzkurt P, Ezer SS, Ince E, Hicsonmez A. Long-term management of corrosive esophageal stricture with balloon dilation in children. Surg Endosc 2010; 24:2287-92. [PMID: 20177917 DOI: 10.1007/s00464-010-0953-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Accepted: 01/23/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE There are only a few studies focused on efficacy and safety of balloon dilation in corrosive esophageal stricture in children. The aim of this study is to assess the long-term clinical results of balloon dilation in the treatment of corrosive esophageal stricture in children. MATERIALS AND METHODS We retrospectively analyzed the management of 18 children (median age 3 years) who were treated with balloon dilation because of caustic esophageal stricture between January 2001 and December 2008. RESULTS A total of 295 sessions of balloon dilation were performed in all patients over an 8-year period. Technical success was achieved in all patients, whereas clinical success was achieved only in eight (44.4%) patients after first dilation. Eight (44.4%) of all patients showed recovery within the first year and another six (33.3%) patients recovered within 2 years. Esophageal perforation occurred in one (5%) patient, during one dilation session (0.33%). The average number of dilation sessions was 12.7, 2.8, and 1, respectively, in the first, second, and third year. There was significant difference between the mean number of dilation sessions in the first and second year, and second and third year (p < 0.01 and p = 0.043). CONCLUSION Short-segment esophageal strictures, improvement of food intake capacity, and increase in intervals of dilation sessions are good patient indicators. We suggest that esophageal balloon dilatation is a safe and effective method of treatment in caustic esophageal strictures and recommend that balloon dilation program be performed for at least 2 years before deciding that dilation has failed and preferring other treatment modalities which have higher risk of complications.
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Affiliation(s)
- Abdulkerim Temiz
- Department of Pediatric Surgery, Baskent University Faculty of Medicine, Ankara, Turkey
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Abstract
PURPOSE OF REVIEW The purpose of this review is to outline the current epidemiology, mechanism of injury, clinical manifestations, management and long-term complications of caustic ingestions in pediatric patients. RECENT FINDINGS Recent data suggest that more than 200 000 exposures to household or industrial cleaning products occur annually in the United States. It is difficult to determine what fraction of these exposures represents caustic ingestions. Caustic ingestions occur most commonly in children less than age 6 years. Because of the accidental nature of the ingestions, the case fatality rate for pediatric patients is significantly less than that of adolescents and adults. Despite laws to limit the concentration of household cleaning products, farm and industrial products and products stored in nonoriginal containers represent a significant source of caustic agents. Endoscopy remains the preferred method of staging injury. In children the absence of symptoms does not predict lack of relevant injury. However, the presence of three or more symptoms is associated with a high likelihood of significant injury. Long-term complications in pediatric patients may be severe and include esophageal cancer. SUMMARY Caustic ingestions remain a significant cause of pediatric morbidity in the United States and abroad. Endoscopy is the primary method of staging injury following a caustic ingestion. Extent of injury at initial evaluation remains the best predictor of morbidity and mortality in pediatric patients following an accidental caustic ingestion.
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Contini S, Garatti M, Swarray-Deen A, Depetris N, Cecchini S, Scarpignato C. Corrosive oesophageal strictures in children: outcomes after timely or delayed dilatation. Dig Liver Dis 2009; 41:263-268. [PMID: 18801710 DOI: 10.1016/j.dld.2008.07.319] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 07/23/2008] [Accepted: 07/25/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND STUDY AIMS Among benign oesophageal lesions, caustic strictures are the most difficult to dilate. In low-income countries, children suffering caustic oesophageal injury are frequently referred to the hospitals late, sometimes weeks after ingestion. Therefore, dilatation may be performed late and in highly fibrotic strictures. Reports about endoscopic and clinical outcome of such delayed dilatations are scanty. The aim of this study was to evaluate the safety and efficacy of late caustic stricture dilatations in children, comparing it with the results of timely dilatations, both performed at the Hospital of the Italian Non-Governmental Organization "Emergency" at Goderich, Sierra Leone. PATIENTS AND METHODS From December 2005 to May 2007, 78 children (<15 years) complaining alkaline caustic ingestion were submitted to oesophageal dilatation, mainly (97%) using Savary dilators. Two groups were identified: children (group 1) with a late treatment (>6 weeks, 37+/-12 weeks), having arrived to the hospital late after ingestion, and children (group 2) dilated timely, i.e. at <6 weeks (4+/-1.4 weeks) after injury. RESULTS Strictures were severe in all patients. Twenty-five children were dilated late after injury (6.4 dilatations/patient) with a follow-up of 11+/-2.5 months. A successful clinical outcome was observed in 91.6%. Four perforations (2.6% procedure-related) and one death (4.0%) were observed. Strictures recurred once in 72% of patients, twice in 31.8%. Thirty-one children were dilated timely (4.5 dilatations/patient) with a follow-up of 10+/-2.1 months and a clinical success rate of 96.7%. Procedure-related perforation rate was 0.7% with one death (3.2%). Stricture recurred once in 30% and twice in 3.3%. CONCLUSIONS Delayed dilatation of caustic oesophageal strictures in children carries a higher risk of perforation and a higher recurrence rate.
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Affiliation(s)
- S Contini
- Department of Surgical Sciences, School of Medicine & Dentistry, University of Parma, Italy.
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Betalli P, Falchetti D, Giuliani S, Pane A, Dall'Oglio L, de Angelis GL, Caldore M, Romano C, Gamba P, Baldo V. Caustic ingestion in children: is endoscopy always indicated? The results of an Italian multicenter observational study. Gastrointest Endosc 2008; 68:434-439. [PMID: 18448103 DOI: 10.1016/j.gie.2008.02.016] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2007] [Accepted: 02/04/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND The ingestion of caustic substances can represent a serious medical problem in children. OBJECTIVE Whether or not an urgent endoscopy should be performed is still a matter of debate, particularly in asymptomatic patients. DESIGN We conducted a multicenter observational study to investigate the predictive value of signs and symptoms in detecting severe esophageal lesions. SETTING AND PATIENTS The records of 162 children who presented with accidental caustic substance ingestion were analyzed. INTERVENTIONS Signs and symptoms were divided into minor (oral and/or oropharyngeal lesions and vomiting) and major (dyspnea, dysphagia, drooling, and hematemesis). An endoscopy was performed in all patients within 12 to 24 hours of the substance being ingested. MAIN OUTCOME MEASUREMENTS The types of substance ingested, signs and symptoms, age, sex, and severity of esophageal injury were correlated. RESULTS Mild esophageal lesions were identified in 143 of 162 patients (88.3%), and severe (third degree) esophageal lesions in 19 patients (11.7%). The risk of severe esophageal lesions without signs and/or symptoms was very low (odds ratio [OR] 0.13 [95% CI, 0.02-0.62], P = .002). Indeed, the presence of 3 or more symptoms is an important predictor of severe esophageal lesions (OR 11.97 [95% CI, 3.49-42.04], P = .0001). Multivariate analysis showed that the presence of symptoms is the most significant predictor of severe esophageal lesions (OR 2.3 [95% CI, 1.57-3.38], P = .001). CONCLUSIONS The results demonstrated that the incidence of patients with third-degree lesions without any early symptoms and/or signs is very low, and an endoscopy could be avoided. The risk of severe damage increases proportionally with the number of signs and symptoms, and an endoscopy is always mandatory in symptomatic patients.
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Affiliation(s)
- Pietro Betalli
- Pediatric Surgery Clinic, University of Padova, Padova, Italy
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