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Zhou J, Liu G, Song X, Liu H, Wang D, Kang Q. Pyloric stenosis secondary to peptic ulcer disease in pediatric patients: A case report and review of the literature. Medicine (Baltimore) 2023; 102:e33404. [PMID: 36961135 PMCID: PMC10036002 DOI: 10.1097/md.0000000000033404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023] Open
Abstract
RATIONALE Pediatric pyloric obstruction is a condition characterized by complete or incomplete obstruction of the distal stomach caused by obstructive lesions of the distal stomach, pyloric duct, or proximal duodenum. Congenital hypertrophic pyloric stenosis is the most common cause of pediatric pyloric obstruction, whereas acquired pyloric stenosis is comparatively rare, with peptic ulcer disease being the most common cause. PATIENT CONCERNS We describe a case of a 5-year-old girl who had peptic ulcer disease and developed scarring pyloric stenosis. We also give comprehensive details of the diagnosis and course of treatment. DIAGNOSIS Intraoperative findings revealed ulcerative, scarring pyloric obstruction. INTERVENTIONS Conservative treatment failed and surgery was subsequently performed. OUTCOMES No further vomiting symptoms occurred after surgery. And 3 months after surgery, the patient had gained weight on average and had no further complaints. LESSONS Although scarring pediatric pyloric blockage due to peptic ulcer is less common, emphasis should be placed on rapid diagnosis by accurate gastroscopy, barium meal of the gastrointestinal tract, or ultrasonography. Depending on the patient's condition, conservative treatment or surgery should be chosen carefully selected.
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Affiliation(s)
- Jiajia Zhou
- Department of General Surgery and Trauma Surgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Guobin Liu
- Department of General Surgery and Trauma Surgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaofeng Song
- Department of General Surgery and Trauma Surgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongjiang Liu
- Department of General Surgery and Trauma Surgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Dengliang Wang
- Department of General Surgery and Trauma Surgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Quan Kang
- Department of General Surgery and Trauma Surgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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2
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Cunningham BS, Alexander CP. Spontaneous Gastric Perforation in a Child and Endoscopic Balloon Dilation for Postoperative Gastric Stenosis. JPGN REPORTS 2022; 3:e199. [PMID: 37168896 PMCID: PMC10158354 DOI: 10.1097/pg9.0000000000000199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/20/2022] [Indexed: 05/13/2023]
Affiliation(s)
- Bethany S. Cunningham
- From the Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Penn State Milton S Hershey Children’s Hospital, Hershey, PA
| | - Chandran P. Alexander
- From the Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Penn State Milton S Hershey Children’s Hospital, Hershey, PA
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3
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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: 2.3] [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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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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5
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Hall AH, Jacquemin D, Henny D, Mathieu L, Josset P, Meyer B. Corrosive substances ingestion: a review. Crit Rev Toxicol 2020; 49:637-669. [PMID: 32009535 DOI: 10.1080/10408444.2019.1707773] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Corrosive chemical substance ingestions are a major problem, especially in developing countries, but also in developed countries such as the United States, France, and Belgium. Ingestions may be deliberate as suicide attempts (mostly in adolescents and adults) or accidental (mostly in children). The results can be devastating in terms of individual suffering and disability, but also in terms of resource utilization and costs. In developing countries, outcomes may be worse because of limited medical/surgical resources. Common sequelae include gastrointestinal (GI) tract (esophagus, stomach, pylorus, and duodenum) stricture formation, GI tract perforation, and hemorrhage. Systemic effects may also occur, such as disseminated intravascular coagulation (DIC), multi-organ system failure, and sepsis. Various interventions in the acute phase to reduce the severity of injury have been attempted, but there are no large controlled clinical trials to demonstrate efficacy. Dilation therapy in various forms is commonly used for the treatment of strictures and a variety of surgical procedures including esophagectomy and delayed replacement may be required in severe corrosive injury cases.
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Affiliation(s)
- Alan H Hall
- Toxicology Consulting and Medical Translating Services, Azle and Springtown, TX, USA.,Colorado School of Public Health, University of Colorado-Denver, Denver, CO, USA
| | | | | | | | - Patrice Josset
- Department of Pathology, Hôpital d'Enfants Armand Trousseau, Director of the Teaching Program of the History of Medicine, Université Pierre et Marie Curie, Paris, France
| | - Bernard Meyer
- Department of Otorhinolaryngology, Université Pierre et Marie Curie, Groupe Hospitalier Pieté-Salpêtrière, Paris, France
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Abstract
Optimal management of pediatric endoscopy requires a multidisciplinary approach. In most hospitals, endoscopy in pediatric patients is performed by conventional gastroenterologists and only a few centers have specialized pediatric gastroenterologists. This is due to the fact that the number of pediatric gastroenterologists is limited and not all of them are experienced in endoscopic techniques. However, there are also some pediatric centers offering a high-quality and high-volume endoscopy service provided by very experienced pediatric gastroenterologists. Up to now, the literature on pediatric endoscopy is rather sparse. In this article, we describe current knowledge and practice of endoscopic procedures in pediatric patients, which should be relevant for both the adult and pediatric gastroenterologists.
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Kirakosyan EV, Lokhmatov MM, Budkina TN, Tupylenko AV, Oldakovsky VI, Dyakonova EY. [Staged endoscopic balloon dilatation for cicatricial pyloric stenosis in children]. Khirurgiia (Mosk) 2019:85-90. [PMID: 31464281 DOI: 10.17116/hirurgia201908185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Secondary pyloric stenosis quickly leads to homeostatic and nutritional disorders that determines the importance of early diagnosis and surgical treatment. In two clinical cases, we have shown that staged endoscopic balloon dilatation of the pylorus is devoid of the most of the known problems and shortcomings of conventional surgery and makes it possible to restore effectively gastrointestinal passage and to improve child's quality of life. This procedure has a high diagnostic and curative value and is followed by positive dynamics of condition of the child with pyloric stenosis.
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Affiliation(s)
- E V Kirakosyan
- Sechenov First Moscow State Medical University of Ministry of Health of the Russia, Moscow, Russia
| | - M M Lokhmatov
- Sechenov First Moscow State Medical University of Ministry of Health of the Russia, Moscow, Russia; National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - T N Budkina
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - A V Tupylenko
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - V I Oldakovsky
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - E Yu Dyakonova
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
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8
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Patel PA, Minhas K, Ang J, Stuart S, De Coppi P, Gnannt R. Non-vascular interventional radiology in the paediatric alimentary tract. Eur J Radiol 2019; 112:72-81. [PMID: 30777223 DOI: 10.1016/j.ejrad.2018.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/03/2018] [Accepted: 12/12/2018] [Indexed: 11/17/2022]
Abstract
Paediatric interventional radiology is an evolving speciality which is able to offer numerous minimally invasive treatments for gastrointestinal tract pathologies. Here we describe interventions performed by paediatric interventional radiologists on the alimentary tract from the mouth to the rectum. The interventions include sclerotherapy, stricture management by dilation, stenting and adjunctive therapies such as Mitomycin C administration and enteral access for feeding, motility assessment and administration of enemas.
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Affiliation(s)
- Premal A Patel
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
| | - Kishore Minhas
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Jestine Ang
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Sam Stuart
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Paolo De Coppi
- Specialist Neonatal and Paediatric Surgery Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Ralph Gnannt
- Bilddiagnostik, Paediatric Interventional Radiology, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland
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9
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Serial Balloon Dilation to Relieve Gastric Outlet Obstruction Induced by the Ingestion of Toilet Cleaner. J Pediatr Gastroenterol Nutr 2018; 66:e56. [PMID: 29356772 DOI: 10.1097/mpg.0000000000001126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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10
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Thomson M, Tringali A, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, Spaander M, Hassan C, Tzvinikos C, Ijsselstijn H, Viala J, Dall'Oglio L, Benninga M, Orel R, Vandenplas Y, Keil R, Romano C, Brownstone E, Hlava Š, Gerner P, Dolak W, Landi R, Huber WD, Everett S, Vecsei A, Aabakken L, Amil-Dias J, Zambelli A. Paediatric Gastrointestinal Endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy Guidelines. J Pediatr Gastroenterol Nutr 2017; 64:133-153. [PMID: 27622898 DOI: 10.1097/mpg.0000000000001408] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This guideline refers to infants, children, and adolescents ages 0 to 18 years. The areas covered include indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileocolonoscopy; endoscopy for foreign body ingestion; corrosive ingestion and stricture/stenosis endoscopic management; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangiopancreatography; and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease has been dealt with in other guidelines and are therefore not mentioned in this guideline. Training and ongoing skill maintenance are to be dealt with in an imminent sister publication to this.
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Affiliation(s)
- Mike Thomson
- *International Academy for Paediatric Endoscopy Training, Sheffield Children's Hospital, Weston Bank, Sheffield, UK †Digestive Endoscopy Unit, Catholic University, Rome, Italy ‡Gedyt Endoscopy Center, Buenos Aires, Argentina §Department of Pediatric Gastroenterology, Centro Hospitalar de São João, Porto, Portugal ||Department of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands ¶Department of Pediatric Gastroenterology and Nutrition, University Children's Hospital Basel, Basel, Switzerland #Department of Gastroenterology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands **Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy ††Department of Pediatric Gastroenterology, Alder Hey Children's Hospital, Liverpool, UK ‡‡Department of Pediatric Surgery and Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands §§Department of Pediatric Gastroenterology, Robert-Debré Hospital, Paris, France ||||Digestive Endoscopy and Surgery Unit, Bambino Gesù Children Hospital-IRCCS, Rome, Italy ¶¶Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia ##Pediatric Gastroenterology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium ***Department of Gastroenterology, Motol University Hospital, Prague, Czech Republic †††Department of Pediatrics, University of Messina, Messina, Italy ‡‡‡IV Medical Department, Rudolfstiftung Hospital, Vienna, Austria §§§Department of General Pediatrics, Children's Hospital Freiburg University, Freiburg, Germany ||||||Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria ¶¶¶Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK ###Department for Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Austria ****GI Endoscopy Unit, OUS, Rikshospitalet University Hospital, Oslo, Norway ††††Gastroenterology and Digestive Endoscopy Unit, Ospedale Nuovo Robbiani di Soresina, Soresina, Italy
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11
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Chao HC. Update on endoscopic management of gastric outlet obstruction in children. World J Gastrointest Endosc 2016; 8:635-645. [PMID: 27803770 PMCID: PMC5067470 DOI: 10.4253/wjge.v8.i18.635] [Citation(s) in RCA: 14] [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: 03/27/2016] [Revised: 06/18/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
Endoscopic balloon dilatation (EBD) and surgical intervention are two most common and effective treatments for gastric outlet obstruction. Correction of gastric outlet obstruction without the need for surgery is an issue that has been tried to be resolved in these decades; this management has developed with EBD, advanced treatments like local steroid injection, electrocauterization, and stent have been added recently. The most common causes of pediatric gastric outlet obstruction are idiopathic hypertrophic pyloric stenosis, peptic ulcer disease followed by the ingestion of caustic substances, stenosis secondary to surgical anastomosis; antral web, duplication cyst, ectopic pancreas, and other rare conditions. A complete clinical, radiological and endoscopic evaluation of the patient is required to make the diagnosis, with complimentary histopathologic studies. EBD are used in exceptional cases, some with advantages over surgical intervention depending on each patient in particular and on the characteristics and etiology of the gastric outlet obstruction. Local steroid injection and electrocauterization can augment the effect of EBD. The future of endoscopic treatment seems to be aimed at the use of endoscopic electrocauterization and balloon dilatations.
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Caustic oesophagitis in children: prevalence, the corrosive agents involved, and management from primary care through to surgery. Curr Opin Otolaryngol Head Neck Surg 2016; 23:423-32. [PMID: 26371603 DOI: 10.1097/moo.0000000000000198] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [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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Endoscopic Treatment of Gastric Outlet Obstruction Secondary to Accidental Acid Ingestion in a Child. J Pediatr Gastroenterol Nutr 2016; 62:90-2. [PMID: 26252917 DOI: 10.1097/mpg.0000000000000936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Accidental corrosive ingestion is not rare in pediatric patients in developing countries. We report a case of gastric outlet obstruction after the accidental ingestion of an acidic substance by a child who was successfully treated with endoscopic balloon dilatation.
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Temiz A. Efficiency of upper gastrointestinal endoscopy in pediatric surgical practice. World J Clin Pediatr 2015; 4:113-119. [PMID: 26566483 PMCID: PMC4637801 DOI: 10.5409/wjcp.v4.i4.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/17/2015] [Accepted: 08/14/2015] [Indexed: 02/06/2023] Open
Abstract
After the introduction of flexible fiber optic endoscopy to pediatric gastroenterology in the 1970s, upper gastrointestinal (UGI) endoscopy can be performed for the diagnosis and treatment of all age groups of children. We review indications, contraindications, preparation of patients for the procedure, and details of diagnostic and therapeutic UGI endoscopy used in pediatric surgery. We also discuss potential complications of endoscopy.
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Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: A comprehensive review. World J Gastroenterol 2013; 19:3918-3930. [PMID: 23840136 PMCID: PMC3703178 DOI: 10.3748/wjg.v19.i25.3918] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/15/2013] [Accepted: 04/28/2013] [Indexed: 02/07/2023] Open
Abstract
Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developing countries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.
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