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Salimi M, Hosseinpour H, Shahriarirad R, Esfandiari S, Pooresmaeel F, Sarejloo S, Foroutan H. Utilization of chest tube as an esophagus stent in pediatric caustic injuries: A retrospective study. World J Clin Pediatr 2022; 11:419-428. [PMID: 36185094 PMCID: PMC9516494 DOI: 10.5409/wjcp.v11.i5.419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/17/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The management of caustic esophageal burns in the pediatric population has changed over the years, while the most optimal management with regards to effectiveness, availability, and cost-beneficent stays controvertible.
AIM To describe how to utilize a chest tube for esophageal stenting in pediatrics.
METHODS Data regarding the etiology, treatment, and complications of caustic injury in pediatrics over 10 years was collected retrospectively. Furthermore, data regarding the patient's follow-up who underwent esophageal chest tube (ECT) were collected. The ECT was prepared by carving a narrowed section in the chest tube while maintaining the radiopaque section. The ECT will then be positioned from the cricopharyngeal and exited through the nostril and fixed on the patient's cheek.
RESULTS During the period of our study, data from 57 patients with an average age of 2.5 years (range 1-12; SD = 1.7) were obtained. The results showed that 89% of esophageal injury was due to alkaline and 9.4% were caused by acidic agents. The treatment methods showed that 29 patients (50.8%) recovered with dilatation alone. In 16 patients (28.06%), the esophageal repair was performed by using the colon, and in 5 patients (8.7%), other surgical methods were used and in 7 patients (12.2%), the ECT stents were used. ECT was inserted in 7 cases with a mean age of 2 (range: 1.5-3) years who were classified as grade IIB or III. Grading was performed by endoscopy assessment on the first day. Antibiotics and corticosteroids were administrated as initial medical management for all patients. ECT implantation was done during the first 8 d for 5 out of 7 cases (mean: 3.8 d). For the 2 patients, ECT was used after 27 (patient 6) d and 83 (patient 7) d. The reason for late stenting in these patients was a postponed referral to our center, in which patient 7 even received 4 dilation episodes before visiting our center. ECT was removed after an average of 44 d in the first 5 patients, while in the other 2 patients (6 and 7) was 2 and 1 wk, respectively. There was no complication related to, or failure of, stent placement. It is worth mentioning that none of the 7 ECT cases required gastrostomy or jejunostomy.
CONCLUSION The ECT method introduced in our study can be used as a broadly available, economic, and easy-use facility for esophageal stenting, particularly in developing countries and emergency departments which have limited access to modern equipment. Further multicenter studies with higher volume patients are required for further deployment of this method.
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Affiliation(s)
- Maryam Salimi
- Department of Orthopaedic Surgery, Shiraz University of Medical Sciences, Shiraz 7138433608, Iran
| | - Hamidreza Hosseinpour
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz 7138433608, Iran
| | | | - Samira Esfandiari
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz 7138433608, Iran
| | - Fatemeh Pooresmaeel
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz 7138433608, Iran
| | - Shirin Sarejloo
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz 07138433608, Iran
| | - Hamidreza Foroutan
- Department of Surgery, Shiraz Laparoscopic Research Center, Shiraz University of Medical Sciences, Shiraz 7138433608, Iran
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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: 1.3] [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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Chen CC, Chen AC, Wu SF. Alkaline substances gastroesophageal injury in young children: emphasis on Asian food preparation habits. J Formos Med Assoc 2021; 120:1907-1913. [PMID: 33422399 DOI: 10.1016/j.jfma.2020.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/15/2020] [Accepted: 12/24/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Ingestion of alkaline substances should not be disregarded because a small amount can cause chemical burns in the esophagus, with esophageal stricture being the most common late complication. METHODS We enrolled children with alkaline corrosive damage receiving treatment at China Medical University Children's Hospital's emergency department between 2008 and 2018. Patients were divided into groups A (ingested causative agents other than alkaline oil), and B (ingested alkaline oil). RESULTS Altogether, 40 (27 [67.5%] male and 13 [32.5%] female) patients aged 7 months-7 years were enrolled. The most commonly ingested agent was alkaline oil (13 cases, 32.5%), followed by oven and drainage cleaners (8 cases, 20%), bleach (6 cases, 15%), laundry and dish cleaners (4 cases, 10%), sodium hydroxide (4 cases, 10%), sodium carbonate (2 cases, 5%), sodium phosphate (2 cases, 5%), and sodium citrate (1 case, 2.5%). High proportions of children had esophagitis (40/40, 100%), erosive gastritis (7/40, 17.5%), and gastric ulcer (6/40, 15%). The incidence of esophageal stricture was 38.4% (5/13) and 7.4% (2/27) in groups B and A, respectively. In group B, 4 children developed growth stunting or malnutrition during the first decade after onset, with reduced immunity and feelings of inferiority. CONCLUSION Alkaline ingestion usually results in esophageal injury that is difficult to cure. Corrosive esophageal strictures cause swallowing difficulties and growth stunting in children. Young children who ingested alkaline oil have more complications. Given that alkaline corrosive injuries are often accidental, prevention of corrosive agent ingestion is crucial.
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Affiliation(s)
- Chin-Chiang Chen
- Department of Pediatrics Gastroenterology, Children's Hospital of China Medical University, Taichung, Taiwan; Department of Pediatrics, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - An-Chyi Chen
- Department of Pediatrics Gastroenterology, Children's Hospital of China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Shu-Fen Wu
- Department of Pediatrics Gastroenterology, Children's Hospital of China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
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Tatli Ö, Pasli S, Imamoğlu M, Cicek M, Yadigaroglu M, Sahin A, Dilaver I, Yulug E, Karaca Y. Potential therapeutic effects of ethyl pyruvate and N-acetyl cysteine in an experimental rat model of corrosive esophageal. Arab J Gastroenterol 2020; 21:260-266. [PMID: 33281067 DOI: 10.1016/j.ajg.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 08/11/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Esophageal burns due to ingestion of corrosive substances are frequently seen in both children and adults. However, there is no standard method of treatment to prevent associated mortality and morbidity. Therefore, this study aimed to evaluate the effects of known antioxidants, namely N-acetyl cysteine and ethyl pyruvate, on esophageal damage due to sodium hydroxide-induced corrosive burns. MATERIALS AND METHODS Thirty-five female rats were randomly assigned to five equal groups. Group 1 was the sham group, while Group 2 was the control group. Group 3 received N-acetyl cysteine, Group 4 received ethyl pyruvate, and Group 5 received both N-acetyl cysteine and ethyl pyruvate. Rats in the "burn" groups were gavage-fed with 0.2mL of 25% NaOH. All esophagi were extracted on day 4 for histopathological evaluation. RESULTS Total histopathological damage scores were evaluated at the end of the study. Groups 3 and 5 were significantly different from the control group in terms of total histopathological scores (p = 0.001), while no significant difference was seen with Group 4. Stenosis index results in groups 3 and 5 were similar to those seen with total histopathological scores (p = 0.004). CONCLUSION N-acetyl cysteine, alone or in combination with ethyl pyruvate, may be useful in the treatment of esophageal damage associated with corrosive substances and in achieving histopathological improvement in an experimental setting.
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Affiliation(s)
- Özgur Tatli
- Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey
| | - Sinan Pasli
- Gümüşhane State Hospital, Department of Emergency Medicine, Gümüşhane, Turkey.
| | - Melih Imamoğlu
- Rize State Hospital, Department of Emergency Medicine, Rize, Turkey
| | - Mustafa Cicek
- Fatih State Hospital, Department of Emergency Medicine, Trabzon, Turkey
| | - Metin Yadigaroglu
- Fatih State Hospital, Department of Emergency Medicine, Trabzon, Turkey
| | - Aynur Sahin
- Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey
| | - Irem Dilaver
- Karadeniz Technical University, Faculty of Medicine, Department of Public Health, Trabzon, Turkey
| | - Esin Yulug
- Karadeniz Technical University, Faculty of Medicine, Department of Histology and Embryology, Trabzon, Turkey
| | - Yunus Karaca
- Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey
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Oliva S, Romano C, De Angelis P, Isoldi S, Mantegazza C, Felici E, Dabizzi E, Fava G, Renzo S, Strisciuglio C, Quitadamo P, Saccomani MD, Bramuzzo M, Orizio P, Nardo GD, Bortoluzzi F, Pellegrino M, Illiceto MT, Torroni F, Cisarò F, Zullo A, Macchini F, Gaiani F, Raffaele A, Bizzarri B, Arrigo S, De' Angelis GL, Martinelli M, Norsa L. Foreign body and caustic ingestions in children: A clinical practice guideline. Dig Liver Dis 2020; 52:1266-1281. [PMID: 32782094 DOI: 10.1016/j.dld.2020.07.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022]
Abstract
Foreign body and caustic ingestions in children are usually the most common clinical challenges for emergency physicians, general pediatricians and pediatric gastroenterologists. Management of these conditions often requires different levels of expertise and competence. Endoscopy is often necessary but there is a high risk of misusing this tool with incorrect timing and indications. The imprecise clinical history frequently leaves clinicians uncertain about timing and nature of the ingestion. Few clinical guidelines regarding management of these ingestions in children have been published, none of which from the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). An expert panel of Italian endoscopists was convened by the SIGENP Endoscopy Working Group to produce the present article that outlines practical clinical approaches to the pediatric patient with a variety of foreign body and caustic ingestions. The Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) has also endorsed the project since many adult endoscopists usually manage children with these conditions. Differently from the other published guidelines, the proposed one focuses on the role of the endoscopists (regardless of whether they are adult or pediatric gastroenterologists) in the diagnostic process of children with foreign body and caustic ingestions.
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Affiliation(s)
- Salvatore Oliva
- Maternal and Child Health Department, Pediatric Gastroenterology and Liver Unit, Sapienza - University of Rome, Rome, Italy.
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology and Pediatrics, University of Messina, Italy
| | - Paola De Angelis
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Isoldi
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Cecilia Mantegazza
- Pediatric Gastroenterology and Digestive Endoscopic Unit, Department of Pediatrics and Pediatric Surgery, University of Milan, Buzzi Children's hospital, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Emanuele Dabizzi
- Gastrointestinal and Interventional Endoscopy Unit, Surgical Department, AUSL Bologna, Bologna, Italy
| | - Giorgio Fava
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Renzo
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Florence, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | | | - Matteo Bramuzzo
- Pediatric Gastroenterology, Digestive Endoscopy and Clinical Nutrition Unit, Department of Pediatric, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Paolo Orizio
- Department of Pediatric Surgery, Spedali Civili Children's Hospital, Brescia, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Sapienza University of Rome, Sant'Andrea University Hospital
| | | | - Maristella Pellegrino
- Pediatric Surgery Unit, Maternal and Child Department, ASST GOM of Niguarda, Milan, Italy
| | - Maria Teresa Illiceto
- Pediatric Gastroenterology and Digestive Endoscopic Unit, Department of Pediatrics, "Santo Spirito" Hospital of Pescara, Italy
| | - Filippo Torroni
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Cisarò
- Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Alessandro Raffaele
- Pediatric Surgery Unit, Department of Maternal and Child health, IRCCS Policlinico San Matteo Pavia and Department of Clinical-Surgical, Diagnostic and Pediatric Science, University of Pavia, Italy
| | - Barbara Bizzarri
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Unit, Institute Giannina Gaslini, Genoa, Italy
| | - Gian Luigi De' Angelis
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Norsa
- Pediatric Hepatology Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
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Povilavičius J, Samalavičius NE, Verkauskas G, Trainavičius K, Povilavičienė M. Conservative treatment of caustic oesophageal injuries in children: 15 years of experience in a tertiary care paediatric centre. PRZEGLAD GASTROENTEROLOGICZNY 2019; 14:286-291. [PMID: 31988676 PMCID: PMC6983767 DOI: 10.5114/pg.2019.90255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/28/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Endoscopic dilatation is good choice of conservative treatment for caustic digestive tract injuries in children. AIM To set up a strategy of management of caustic digestive tract injury based on our experience and literature review. MATERIAL AND METHODS We retrospectively analysed medical records of 34 paediatric patients who were admitted to the Centre of Paediatric Surgery of the Children's Hospital between 2000 and 2017. Age at presentation, gender, anatomic location, circumstances and distribution of injury, early and late complications, clinical signs, and the first aid were analysed. Upper gastrointestinal (GI) endoscopy was performed within 12-24 h after ingestion in all cases. The Zargar classification system was used to grade the severity of the injury. Fisher's exact test was used for statistical analysis, with p < 0.05 considered as the limit of statistical significance. RESULTS The upper GI endoscopy revealed caustic injuries in 5 (15%) and 8 (23%) patients were classified as grade IIa and IIb, respectively. Oesophageal and ventricle caustic injuries in 3 (9%) and 2 (6%) patients were classified as grade IIIa and IIIb, respectively. Thirteen patients with grade IIa and IIIb injuries suffered permanent damage and required repeated dilatation. All patients underwent stricture treatment using late or early endoscopic dilatation of the oesophagus. An average of 15 dilatation procedures were required to achieve a satisfactory lumen. CONCLUSIONS Our experience of 34 children revealed that endoscopic dilatation may be required as a primary treatment for oesophageal strictures.
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Affiliation(s)
- Jonas Povilavičius
- Department of Paediatric Surgery, Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Narimantas Evaldas Samalavičius
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
- Clinic of Internal, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Gilvydas Verkauskas
- Department of Paediatric Surgery, Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Kęstutis Trainavičius
- Department of Paediatric Surgery, Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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Long-Term Outcomes of Caustic Esophageal Stricture with Endoscopic Balloon Dilatation in Chinese Children. Gastroenterol Res Pract 2018; 2018:8352756. [PMID: 30158970 PMCID: PMC6109481 DOI: 10.1155/2018/8352756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/31/2018] [Accepted: 07/04/2018] [Indexed: 12/12/2022] Open
Abstract
Caustic esophageal stricture (CES) in children still occurs frequently in developing countries. We aimed to evaluate the long-term outcomes of endoscopic balloon dilatation (EBD) in treating CES in children and the influencing factors associated with outcome. We retrospectively reviewed the data of all patients who had a diagnosis of CES and underwent EBD from August 1, 2005, to December 31, 2014. The primary outcome was EBD success, which was defined as the maintenance of dysphagia-free status for at least 12 months after the last EBD. The secondary outcome was to analyze influencing factors associated with EBD success. Forty-three patients were included for analysis (29 males; mean age at first dilatation 44 months with range 121 months). 26 (60.5%) patients had long segment (>2 cm) stricture. A total of 168 EBD procedures were performed. Twenty-six (60.5%) patients were considered EBD success. Seventeen (39.5%) patients failed EBD and required stent placement and/or surgery. Patients in the EBD success group had significantly shorter stricture segments when compared to the EBD failure group (t = 2.398, P = 0.018, OR = 3.206, 95% OR: 1.228-8.371). Seven (4.4%) esophageal perforations occurred in 6 patients after EBD. Stents were placed in 5 patients, and gastric tube esophagoplasty was performed in 14 patients. In conclusion, 26 (60.5%) of 43 children with CES had EBD success. Length of stricture was the main influencing factor associated with EBD treatment outcome.
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Johnson NP, Bruno EC. Novel Use of Ophthalmic pH Paper to Diagnose Malicious Caustic Ingestion in a Pediatric Patient. Clin Pract Cases Emerg Med 2018; 2:39-42. [PMID: 29849286 PMCID: PMC5965137 DOI: 10.5811/cpcem.2017.11.36367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 12/11/2022] Open
Abstract
Occult caustic ingestion in the pediatric population is a challenging diagnosis to make in the emergency department. Failure to suspect and diagnose a caustic ingestion can lead to potentially life-changing comorbidities. Historically, the diagnosis of caustic ingestion has been clinical without any suitable diagnostic tools to aid in the suspicion of occult cases. In this case, we describe a novel use of ophthalmic pH paper to diagnose caustic ingestion in a three-year-old.
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Affiliation(s)
- Neal P Johnson
- University of Tennessee College of Medicine, Saint Thomas Rutherford Hospital, Department of Emergency Medicine, Murfreesboro, Tennessee
| | - Eric C Bruno
- University of Tennessee College of Medicine, Saint Thomas Rutherford Hospital, Department of Emergency Medicine, Murfreesboro, Tennessee
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Bosnali O, Moralioglu S, Celayir A, Pektas OZ. Is rigid endoscopy necessary with childhood corrosive ingestion? a retrospective comparative analysis of 458 cases. Dis Esophagus 2017; 30:1-7. [PMID: 26822961 DOI: 10.1111/dote.12458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of this study was to determine the necessity of endoscopy in cases in which a corrosive substance was ingested and to find a practical way to avoid unnecessary endoscopies for similar cases in the future. The clinical records of 458 hospitalized cases with clinical histories of corrosive substance ingestion between January 2007 and December 2013 were retrospectively reviewed. The demographics of the cases, the ingested substances, and the rigid endoscopy findings were evaluated. The three most commonly ingested corrosive agents were household bleach (22.9%), household degreaser (15.9%), and drain cleaner (13.1%). Rigid esophagoscopy was performed in 367 of the 458 cases. Corrosive agents were grouped according to their purpose of household use; eight groups were created. The degree of corrosive injury observed in the different groups was compared with the degree of injury caused by household bleach. Among the corrosive agent groups, dishwashing machine products (Gr.1), laundry products (Gr.2), liquid cleaners (Gr.3), and household bleach (Gr.4) did not cause high-grade injuries. The resulting injuries and esophagoscopy results among the above groups, whether symptomatic or not, did not differ from one another. Corrosive agents such as drain cleaner (Gr.6), household degreaser (Gr.7), and several other acidic products (Gr.8) caused high-grade injuries in the esophagus; however, lime remover/HCl (Gr.5) did not. Thus, hospitalization and rigid endoscopy seem unnecessary to assess esophageal injury in most cases, if the ingested corrosive agent fits into group 1, 2, 3, or 4 and if the patient can be easily fed. Esophagoscopy is useful to shorten the hospitalization times in cases where strong corrosive agents were ingested, such as those in groups 5, 6, 7, and 8.
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Affiliation(s)
- O Bosnali
- Department of Pediatric Surgery, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Türkiye
| | - S Moralioglu
- Department of Pediatric Surgery, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Türkiye
| | - A Celayir
- Department of Pediatric Surgery, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Türkiye
| | - O Z Pektas
- Department of Pediatric Surgery, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Türkiye
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Rafeey M, Ghojazadeh M, Sheikhi S, Vahedi L. Caustic Ingestion in Children: a Systematic Review and Meta-Analysis. J Caring Sci 2016; 5:251-265. [PMID: 27757390 PMCID: PMC5045959 DOI: 10.15171/jcs.2016.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 10/02/2015] [Indexed: 02/06/2023] Open
Abstract
Introduction: Caustic ingestion that occurs accidently is one of the most common problems in children. Methods: This systematic review has been performed by searching the databases including Science Direct, ProQuest, Google Scholar, and PubMed. A strategic search was performed with keywords including caustic, corrosive, ingestion, and children, and was limited to articles in English and Persian. Data were analyzed using Comprehensive Meta-Analysis2 and PASW Statistics 18. Results: We selected 64 articles regarding caustic ingestion with a total sample of 11,345 cases. The data analysis indicated a higher consumption in young boys (age range 2.78 (2.02) years (OR=0.53 with a 95% confidence interval of 0.49-0.57 (P=0.08)). The most common caustic substances were household cleaning agents, particularly bleaches and cleaners. Esophageal cancer and death were reported as well as digestive and respiratory complications. Invasive and expensive techniques are frequently used for diagnosis, treatment and follow up. Conclusion: The results demonstrated that although caustic ingestion is a serious problem among children, it is a preventable and manageable issue. Therefore, appropriate efforts by families, government, factories, health team and media should be made to handle adequately this matter.
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Affiliation(s)
- Mandana Rafeey
- Department of Pediatrics Gastroenterology, Medicine Faculty, Liver & Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Department of Physiology, Medicine Faculty, Liver & Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeede Sheikhi
- Clinical Librarian, Liver & Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Vahedi
- Liver & Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Çiftçi ÖD, Gül SS, Açıksarı K, Maman A, Çavuşoğlu T, Bademci R, Taskiran D, Erbaş O. The diagnostic utility of scintigraphy in esophageal burn: a rat model. J Surg Res 2016; 200:495-500. [DOI: 10.1016/j.jss.2015.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 07/29/2015] [Accepted: 09/03/2015] [Indexed: 01/21/2023]
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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: 24] [Impact Index Per Article: 3.0] [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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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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Pediatric caustic ingestion: eight years experience. Indian J Pediatr 2015; 82:381-2. [PMID: 25319814 DOI: 10.1007/s12098-014-1588-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 09/10/2014] [Indexed: 01/21/2023]
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15
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Urganci N, Usta M, Kalyoncu D, Demirel E. Corrosive substance ingestion in children. Indian J Pediatr 2014; 81:675-9. [PMID: 23918323 DOI: 10.1007/s12098-013-1170-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/26/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To evaluate children who ingested corrosive substances, in terms of demographic features, nature of ingested substances, clinical findings, management and complications. METHODS A total of 1709 cases aged between 0 and 16 y who ingested corrosive substance were analyzed retrospectively by evaluating the medical records of the patients. RESULTS The mean age of the cases was 35.23 ± 30.65 mo and male:female ratio was 1.45. Forty one percent of corrosive substances causing intoxication contained NaOH. Thirty percent of the families consisted of 5 or more members. Fourteen percent of the mothers were illiterate. Stricture formation was observed in 29 (1.69 %) of the cases during follow-up. In 79.31 % of those cases alkaline substance ingestion was responsible for stricture development. It was found that stricture formation occurred more frequently among cases who were older than 5 y of age and this finding was statistically significant (p = 0.001). CONCLUSIONS The cases older than 5 y of age with the diagnosis of grade 2b esophagitis must be followed up closely for the stricture formation. In order to protect children from corrosive ingestion, importance must be given to preventive measures such as education of families, keeping and storing these agents out of the reach of children and providing safety caps for these products.
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Affiliation(s)
- Nafiye Urganci
- Division of Pediatric Gastroenterology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
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16
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Usta M, Erkan T, Cokugras FC, Urganci N, Onal Z, Gulcan M, Kutlu T. High doses of methylprednisolone in the management of caustic esophageal burns. Pediatrics 2014; 133:E1518-24. [PMID: 24864182 DOI: 10.1542/peds.2013-3331] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Caustic substance ingestion in childhood is a public health issue in developing countries, and several management protocols have been proposed to prevent the resulting esophageal strictures. The role of corticosteroids in preventing corrosive-induced strictures is controversial. Our aim was to study the influence of high doses of corticosteroids in preventing esophageal strictures. METHODS Eighty-three children with a mean age of 4.10 6 2.63 years and with grade IIb esophageal burns (an esophagogastroscopy was performed within 24–48 hours of injury) due to corrosive substance ingestion were enrolled in our study between 2005 and 2008. Forty-two children (study group) received methylprednisolone (1 g/1.73 m2 per day for 3 days), ranitidine, ceftriaxone, and total parenteral nutrition. Forty-one children (control group) were administered the same regimen excluding methylprednisolone. Stricture development was compared between groups based on endoscopic and radiologic findings. RESULTS During the endoscopic examination, stricture development was observed in 4 patients (10.8%) in the study group and in 12 patients (30%) in the control group. The difference was statistically significant (P = .038). The stricture development rate in the upper gastrointestinal system with barium meal was 14.3% and 45.0% in the study and control groups, respectively. The difference was statistically significant (P = .004). The duration of total parenteral nutrition was shorter in the study group compared with the control group (P = .001). High doses of methylprednisolone were well tolerated in the study group without any side effects. CONCLUSIONS High doses of methylprednisolone used for the management of grade IIb esophageal burns may reduce stricture development.
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Affiliation(s)
- Merve Usta
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Tülay Erkan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fugen Cullu Cokugras
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nafiye Urganci
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Zerrin Onal
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey; and
| | - Mahir Gulcan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Acibadem University Medical Faculty, Istanbul, Turkey
| | - Tufan Kutlu
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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17
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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: 3.4] [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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Chang CF, Kuo SP, Lin HC, Chuang CC, Tsai TK, Wu SF, Chen AC, Chen W, Peng CT. Endoscopic balloon dilatation for esophageal strictures in children younger than 6 years: experience in a medical center. Pediatr Neonatol 2011; 52:196-202. [PMID: 21835364 DOI: 10.1016/j.pedneo.2011.05.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Revised: 07/28/2010] [Accepted: 08/30/2010] [Indexed: 12/14/2022] Open
Abstract
Esophageal strictures in children may be caused by congenital anomaly, caustic agent or foreign body ingestion, complication of reflux esophagitis, and after esophageal surgery. Accidental ingestion of alkaline fluid is the most common cause of corrosive esophagitis in children in Taiwan. In this article, we studied 10 pediatric patients who had esophageal strictures and required endoscopic balloon dilatation (EBD) therapy under general anesthesia from January 2003 to June 2009. The median age of the studied children who received their first EBD treatment was 36.2 months (13.4-60.9 months), with a dilator size of 8.0mm (5-12 mm). The interval between injury and initial EBD was 3.0 months (1.3-60.8 months). The treatment duration averaged 16.7 months (3.0-69.3 months), with 13.5 (4-31) instances of EBD therapy per patient. The greater the length of stricture, the more number of times EBD was needed. In these cases, no severe complication was found after the procedure. The result indicated that EBD under general anesthesia was a safe and effective method to resolve the symptom of dysphagia and diet condition. Because of the limited number of study cases, long-term studies are required to further confirm the clinical effect of EBD under general anesthesia.
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Affiliation(s)
- Chih-Feng Chang
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
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19
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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: 2.6] [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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20
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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: 2.9] [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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21
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Youn BJ, Kim WS, Cheon JE, Kim WY, Shin SM, Kim IO, Yeon KM. Balloon dilatation for corrosive esophageal strictures in children: radiologic and clinical outcomes. Korean J Radiol 2010; 11:203-10. [PMID: 20191068 PMCID: PMC2827784 DOI: 10.3348/kjr.2010.11.2.203] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 11/20/2009] [Indexed: 12/21/2022] Open
Abstract
Objective We retrospectively evaluated the effectiveness of the esophageal balloon dilatation (EBD) in children with a corrosive esophageal stricture. Materials and Methods The study subjects included 14 patients (M:F = 8:6, age range: 17-85 months) who underwent an EBD due to a corrosive esophageal stricture. The causative agents for the condition were glacial acetic acid (n = 9) and lye (n = 5). Results A total of 52 EBD sessions were performed in 14 patients (range 1-8 sessions). During the mean 15-month follow-up period (range 1-79 months), 12 patients (86%) underwent additional EBD due to recurrent esophageal stricture. Dysphagia improved after each EBD session and oral feeding was possible between EBD sessions. Long-term success (defined as dysphagia relief for at least 12 months after the last EBD) was achieved in two patients (14%). Temporary success of EBD (defined as dysphagia relief for at least one month after the EBD session) was achieved in 17 out of 52 sessions (33%). A submucosal tear of the esophagus was observed in two (4%) sessions of EBD. Conclusion Only a limited number of children with corrosive esophageal strictures were considered cured by EBD. However, the outcome of repeated EBD was sufficient to allow the children to eat per os prior to surgical management.
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Affiliation(s)
- Byung Jae Youn
- Department of Radiology, Seoul National University College of Medicine and the Institute of Radiation Medicine, SNUMRC, Seoul 110-744, Korea
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Costa DT, Serra MIF, Nascimento-Carvalho CM. An 11-month-old girl with saliva impaction and vomiting. Diagnosis: congenital esophageal stenosis. Pediatr Ann 2009; 38:603-4, 606. [PMID: 19968202 DOI: 10.3928/00904481-20091016-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Davi T Costa
- Department of Pediatrics, Federal University of Bahia, Salvador, Brazil.
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23
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Rafeey M, Shoaran M. Clinical characteristics and complications in oral caustic ingestion in children. Pak J Biol Sci 2009; 11:2351-5. [PMID: 19137870 DOI: 10.3923/pjbs.2008.2351.2355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study is to evaluate the prevalence of gastrointestinal symptoms in caustic ingestion, the severity of lesions and the role of early conducted endoscopy in prediction of outcome. In a cross-sectional study all children hospitalized for caustic ingestion during two years, aged 12 years and younger were evaluated for clinical history, endoscopic findings, method of treatment and observed complications. Out of 51 children, 8 consumed acidic and 43 alkaline materials. The mean age of the children was 35.9 +/- 18 months. Thirty four (66.7%) patients were male and 17 (33.3%) were female. In endoscopic survey, 38% had grade 1 and 62% had a burning intensity of grade 2 or higher. During the follow-up, esophageal structure developed in 5 cases and Gastric Outlet Obstruction (GOO) in 1 case. Two of 5 patients with stricture were treated by endoscopic dilatation and 3 of them underwent colon transposition surgery. Gastrectomy was done for the patient with GOO. Esophageal structure as a complication had a more incidence in acid ingestion. Gastric Otlet Obstruction (GOO) occurred in a case of acid ingestion. One of the patients died. Positive statistical relation between early endoscopic findings and complications found in control endoscopy suggest that early endoscopy probably is safe and provides important prognostic information. The role of prevention as a comprehensive strategy promoted by medical councils and the mass media is imperative.
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Affiliation(s)
- M Rafeey
- Liver and Gastrointestinal Disease Research Center, Tabriz University (Medical Sciences), Tabriz, Iran
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24
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Park JY, Shin JY, Yang HR, Ko JS, Kim WS, Seo JK. Usefulness of early endoscopy for predicting the development of stricture after corrosive esophagitis in children. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.4.446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ji Yong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Youn Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Sung Ko
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Kee Seo
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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25
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Abstract
Caustic injury to the aerodigestive tract remains a significant medical and social concern despite various efforts to minimize hazards of caustic household products. Agents with a pH less than two or greater than 12 are extremely corrosive, causing damage that can range from mild to extensive, including esophageal perforation leading to mediastinitis and death at the extreme scale. Methods include retrospective case note review of all admissions to the otolaryngology unit with caustic injury that underwent esophagoscopy to the Children's Hospital Westmead between 1990 and 2007. A protocol-based management system with antibiotics and steroids together with esophagoscopy at 48 hours was implemented. A total of 50 admissions were identified with an average follow-up of 5 years. There were a total of 28 males and 22 females with a median age of 22 months. Forty-nine cases (98%) were accidental. Thirty-eight cases (76%) occurred within the interiors of the family home with the kitchen being the common location. Another seven (14%) occurred within the external environment of the home, usually in the garage or pool shed. The causative agents were varied with 37 (74%) being alkali, three cases (6%) being acidic, and other agents, such as chlorine bleach, being the remainder. The most frequently ingested alkalis were dishwashing powder and disinfectants closely followed by degreasers. Twenty-five children (50%) drank directly from a container with the remainder ingesting granules or powder directly. At esophagoscopy, 17 cases (34%) had grade 1 injury and 10 (20%) had grade 2 injury. Fifty percent of patients of grade 2 injury subsequently developed strictures requiring multiple dilatations. Importantly, six cases (12%) had evidence of esophageal injury without oral injury. Caustic injuries continue to be a significant morbidity in the pediatric patient group. Most cases are still happening as a result of accidental ingestion from unmarked containers within reach of children at home. Oral injury is not always a useful marker of more significant distal injury. A protocol-based management can identify children at risk for long-term stricture earlier.
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Affiliation(s)
- F Riffat
- Department of Otolaryngology, Children's Hospital Westmead, Westmead NSW, Australia
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26
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Abstract
Nonaccidental injury is always a concern when children present with unusual injuries. The case of a child who presented with a partial thickness burn secondary to prolonged contact with a liquid biological laundry detergent is described. Initially there was some doubt as to whether the agent in question could cause this injury but a small experiment on a volunteer confirmed it was possible.
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Affiliation(s)
- Alan J Howieson
- Oddstock Burns Unit, Salisbury District Hospital, Salisbury, Wiltshire, UK.
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27
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BURMEISTER BH, WALPOLE ET, THOMAS J, SMITHERS BM. Two cases of esophageal carcinoma following corrosive esophagitis successfully treated with chemoradiation therapy. Asia Pac J Clin Oncol 2007. [DOI: 10.1111/j.1743-7563.2007.00096.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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28
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Doğan Y, Erkan T, Cokuğraş FC, Kutlu T. Caustic gastroesophageal lesions in childhood: an analysis of 473 cases. Clin Pediatr (Phila) 2006; 45:435-8. [PMID: 16891276 DOI: 10.1177/0009922806289618] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Ingested corrosive agents produce oropharyngeal and gastroesophageal injuries ranging from minor burns to severe necrosis, depending on the agent amount, concentration, and duration of exposure. The aim of this study was to present our patients with corrosive ingestion retrospectively. Four hundred seventy-three children younger than 16 years of age (mean age, 3.7+/-0.1 years) who were admitted to our hospital for suspected corrosive ingestion between the years 1995 and 2003 were studied. Two hundred eighty-six (60.5%) of 473 patients were males. Household bleaches (36.6%) and oven cleaners (23%) were the most frequently encountered corrosive agents. During endoscopy, lesions in the esophagus were recorded in 379 children. Eighty-one of the cases had gastric lesions. During the follow-up, esophageal stricture, esophageal perforation, and gastric outlet obstruction (GOO) developed in 11 cases, 1 case, and 2 cases, respectively. Caustic ingestion of alkali substances such as oven cleaner seem to cause more severe injuries. Early admission to the hospital with clinical and endoscopic evaluation and early surgery when required may reduce morbidity and mortality.
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Affiliation(s)
- Yaşar Doğan
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
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Baskin D, Urganci N, Abbasoğlu L, Alkim C, Yalçin M, Karadağ C, Sever N. A standardised protocol for the acute management of corrosive ingestion in children. Pediatr Surg Int 2004; 20:824-8. [PMID: 15538587 DOI: 10.1007/s00383-004-1294-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2004] [Indexed: 02/08/2023]
Abstract
Oesophageal strictures developing after caustic ingestion in children are a serious problem, and several protocols to prevent stricture formation have been proposed. A prospective clinical trial was conducted for preventing strictures in caustic oesophageal burns in a single clinic, and the results are presented. All children with caustic ingestion who had oesophagoscopy for diagnosing the severity of the burn were included in the study. Eighty-one children were included in the series, with ages ranging between 3 months and 12 years. The patients were given nothing by mouth until oesophagoscopy. IV fluids, broad-spectrum antibiotics, ranitidine, and a single-dose steroid were given. Oral burns were positive in 66 patients. Oesophagoscopy revealed a normal oesophagus in nine patients, grade 1 burn in 24, grade 2a in 21, grade 2b in 23, grade 3a in two, and grade 3b in one. Patients with grade 1 and 2a burns were discharged after oesophagoscopy. Patients with grade 2b and all grade 3 burns were given nothing by mouth for a week except water when swallowing their saliva, and were fed via total parenteral nutrition. After the 1st week, if there was no problem with swallowing, liquid foods were introduced. No intraluminal tubes were used. At the end of the 3rd week, a barium meal was administered and an upper gastrointestinal series taken. Dilatation was performed at 2-week intervals for strictures, which developed in one grade 2a patient, six grade 2b patients, and the grade 3b patient. Only one of these patients is currently on an oesophageal dilatation program. Limiting oral intake and avoiding foreign bodies in the oesophagus seem to provide a good success rate; however, further prospective studies are needed to decrease the incidence of corrosive oesophageal strictures.
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Affiliation(s)
- Didem Baskin
- Department of Pediatric Surgery, Sisli Etfal Education and Research Hospital, Pehlivanyani Sok. 7/4, 34934 Mecidiyeköy, Istanbul, Turkey.
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