Segmental and total oesophageal transit time in patients with corrosive-induced oesophageal stricture

Outcomes of Endoscopic Dilation in Patients with Esophageal Anastomotic Strictures: Comparison Between Different Etiologies

BACKGROUND AND AIMS

This retrospective study was aimed at assessing the efficacy of endoscopic dilation for esophageal anastomotic strictures, and to compare response between caustic anastomotic strictures (CAS) and non-caustic anastomotic strictures (NCAS).

MATERIALS AND METHODS

Patients with anastomotic strictures (enrolled during January 1996-December 2015) were analyzed. Short- and long-term outcomes of dilation, in terms of clinical success, refractory, and recurrent strictures were compared between NCAS and CAS. Patients with refractory and recurrent strictures were managed with adjunctive therapy including intralesional steroids. Factors predicting refractoriness at start of dilation and reasons for more than ten lifetime dilations were also evaluated.

RESULTS

Of the 142 patients, 124 (mean age-44.02; males-74) underwent dilation. Clinical success was achieved in 113 (91.3%) patients requiring a median [Interquartile range (IQR)] of 4 (2-10) sessions. The number of dilations to achieve clinical success, refractory strictures, and recurrent strictures, and the use of adjunctive therapy were significantly higher for CAS than for NCAS. Intralesional steroid use decreased periodic dilation index (PDI) significantly in CAS. Caustic etiology and starting dilation diameter of < 10 mm were found to be predictors of refractoriness, with the former alone being an independent predictor of more than ten lifetime dilations. No patient had free perforation; however, five required revision surgery.

CONCLUSION

Patients with CAS fared worse than those with NCAS in terms of number of dilations, refractoriness, recurrence of strictures, and need of adjunctive therapy. Endoscopic dilation can successfully ameliorate dysphagia due to anastomotic strictures in a majority of patients.

Effects of sodium hydroxide exposure on esophageal epithelial cells in an in vitro ovine model: implications for esophagus tissue engineering

BACKGROUND

Esophagus tissue engineering holds promises for esophageal replacement after severe caustic injuries. The aim of this study was to determine whether viable esophageal epithelial cells could be isolated from an esophagus exposed to varying concentrations of alkali with regard to number, viability, and morphology during in vitro culture.

METHODS

Ovine esophagi were exposed to phosphate-buffered saline 2.5%, 15%, or 25% sodium hydroxide (NaOH). The effect of NaOH concentrations on epithelial damage was assessed histologically. Esophageal epithelial cells were then isolated, and cell count and viability were investigated. Finally, cell number, viability, and morphology of esophageal epithelial cells were determined for 24 days of in vitro culture.

RESULTS

Histologic analysis showed a progressive destruction of the epithelium proportional to increasing NaOH concentrations. Esophagi treated with phosphate-buffered saline and 2.5% NaOH showed significantly higher viable cell counts after isolation and culture in comparison with those treated with 15% to 5% NaOH.

CONCLUSION

The evidence presented in this study indicates that epithelial biopsies from an esophagus exposed to low concentrations (2.5%) of NaOH will still yield large numbers of viable cells suitable for tissue engineering applications. In cases of exposure to higher concentrations (15%-25%), alternative cell sources for epithelial regeneration, such as stem cells, will be necessary for tissue engineering applications.

Caustic ingestion and oesophageal damage in children: Clinical spectrum and feeding practices

AIM

The study aims to evaluate the association of oesophageal damage with clinical data and feeding practices in children who suffered a caustic substance ingestion (CSI).

METHODS

Cross-sectional design was used in this study. The setting was at a paediatric referral hospital in 2006. Ninety-four children with CSI were used as study samples, with mean age of 38.4 months, and 37.2% were females. The independent variable was oesophageal damage; the dependent variables were clinical data and feeding practices.

RESULTS

Main symptoms included salivation, oropharyngeal burns and vomiting. On endoscopy, 84.6% had second- or third-degree burns. Oesophageal stricture occurred in 48.9%. Severe burns were associated with oesophageal stricture and ingestion of alkaline products; dysphagia was associated with oesophageal stricture. In about one fourth of the cases, a nutritional intervention with complete and balanced liquid diets was required to maintain the adequate daily recommended intake (DRI).

CONCLUSIONS

Alkali ingestion was associated with severe burns and oesophageal stricture. The presence of oesophageal strictures and dysphagia required changes in the feeding practices in order to maintain an adequate nutritional status and/or to complete their DRI.