Nasogastric tube as protection for recurrent oesophageal stricture: A case report

Corrosive substances ingestion: a review

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.

Double Lumen Polyamide Tube-stent for the Treatment of Recurrent Postcorrosive Esophageal Stenosis

This article presents the results of endoscopic treatment for recurrent postcorrosive esophageal stenosis with a tube-stent developed at our institution. The tube-stent was implanted in 5 children with corrosive esophageal injury at the age of 2 to 8.5 years after 7 to 64 dilatation sessions during 5 to 118 months. In total, 13 tube-stents were implanted. One patient had undergone 9 procedures during 2.5 years and the tube-stent remained in place for 14 to 250 days. This patient was tube-stent-dependent due to the lack of any possibility of surgical reconstruction. Two patients had the tube-stent removed after 150 to 205 days and they remain free from esophageal restenosis. One patient did not tolerate the tube-stent, evacuated it after 1 day and was referred for surgical esophagus replacement. One patient is currently still being treated with the tube-stent. Tube-stent was well tolerated and it may be effective in children with recurrent critical postcorrosive esophageal stenosis.

Caustic Esophageal Stenosis: A Case Report of Endoscopic Dilation With a Dynamic Stent

INTRODUCTION

The management of esophageal strictures has evolved from surgical treatment to the endoscopic dilation and, more recently, esophageal stenting.

CLINICAL CASE

We describe a case of a two-year-old boy with a double stenosis of the esophagus resulting from accidental ingestion of strong alkaline liquid. After several unsuccessful endoscopic dilations for three years and even topical mitomicin, it was decided to place a dynamic stent developed by the Digestive Surgery and Endoscopic Unit of the Bambino Gesù Hospital, Rome. The stent is a custom silicon device built coaxially on a nasogastric tube that is inserted after stricture dilations, by endoscopic guidance, and then fixed outside the nose. The device was removed after seven weeks with good clinical outcome (no dysphagia more than a year of follow-up).

CONCLUSION

This case confirms that the dynamic stent is a simple device that may avoid aggressive surgical substitution in cases of refractory strictures.

Endoscopic therapy of oesophageal strictures in children - a multicentre study

INTRODUCTION

Oesophageal strictures are rare in children but may require endoscopic dilation.

AIM

To gather information on centres performing endoscopic oesophageal dilation in Poland.

MATERIAL AND METHODS

The data were obtained from questionnaires concerning the relevant data mailed to 22 paediatric endoscopy centres. Completed questionnaires were received from 11 centres.

RESULTS

In 2010 the 11 Polish paediatric endoscopy centres performed a total of 10,650 endoscopic procedures. This included 347 oesophageal dilations in 106 paediatric patients aged from 1 month to 18 years. The numbers of patients treated at individual centres ranged from 2 to 40. The indications for oesophageal dilation were as follows: postoperative strictures in 68 children, oesophageal burns in 17 children, postinflammatory strictures in 14 children, achalasia in 4 children, and strictures caused by a foreign body in 3 children. Rigid guidewire dilators were used in the majority of procedures (271), rigid dilators without a guidewire in 32 procedures, and balloon dilators in 45 procedures. A total of 203 procedures were conducted under fluoroscopic guidance, and 144 without the use of fluoroscopy. The number of dilating sessions performed in individual children varied from 1 to 6 and more.

CONCLUSIONS

Oesophageal dilation constituted a minor proportion of all paediatric endoscopic procedures. The majority of children requiring dilation were patients up to 3 years of age with postoperative oesophageal strictures. In the majority of the centres rigid guidewire dilators were used, and in one third of the procedures these dilators were introduced without fluoroscopic guidance.