Thoracic ConditionCorticosteroid injection of impassable caustic esophageal strictures without dilatation: Does it pave the way to interval endoscopic dilatation?
Introduction
Corrosives ingestion is common in children, especially in the developing countries [1]. The corrosive substance may be an acid or an alkali. Alkali causes severe damage to the esophagus owing to the liquefactive necrosis which results from it [2].
Some children can pass the acute stage without permanent damage to the esophagus, while others develop esophageal stricture. Clinical manifestations of esophageal strictures vary from drooling of saliva to occasional dysphagia according to the degree of the stricture [3].
Endoscopic dilatation is the mainstay of treatment of caustic esophageal strictures. In mild and moderate esophageal strictures, graded dilatation using Savary–Gilliard dilators is usually possible, while in severe strictures, this could not be achieved. In the past decades, these patients were candidate for esophageal replacement [4]. Advancement in techniques of dilatation like corticosteroid injection, Mitomycin application and endoscopic incision of the stricture has improved the results of the endoscopic dilatation and decreased the need for esophageal replacement [5].
In this study, we aimed to evaluate our results of injecting impassable caustic esophageal strictures with corticosteroid then trying to dilate them to decrease the need for replacing the esophagus.
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Material and methods
During the period from June 2003 to May 2017, and after approval of the institutional review board, 340 patients, in whom a trial of endoscopic dilatation after corrosive ingestion failed, presented to Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University. The patients presented with dysphagia of variable degrees; it ranged from absolute dysphagia to dysphagia to some solids.
The initial management was done in the toxicology department in our hospital. This consisted of
Results
In our series, 210 patients (62%) ingested alkaline corrosives (household bleaches) and 130 patients (38%) ingested acidic corrosives (drain cleaners). 194 patients (57%) were males and 146 patients (43%) were females. Their age ranged between 1.5 and 6 years (mean 3 years and median 3.5 years).
Out of the 340 patients with failed first trial of endoscopic dilatation followed by four-quadrant corticosteroid injection, the second trial of endoscopic dilatation after 2 weeks was possible in 255
Discussion
Corrosive ingestion is common in children, especially in the developing countries. The corrosive substance can cause damage to the esophagus or to the stomach according to its nature. Follow up of the child is required to diagnose and manage those who will develop strictures [6].
Flexible endoscopy is the cornerstone of treatment in those who have dysphagia following history of corrosive ingestion. The endoscope shows the stricture as narrowing in the esophageal lumen; sometimes, the endoscope
Conclusion
Four-quadrant corticosteroid injection of impassable caustic esophageal strictures followed by endoscopic dilatation is a minor procedure which decreased the need of a major procedure to replace the injured esophagus.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethical approval
The study was approved by the institutional review board.
Informed consent
Informed consent was obtained from all individual participants included in the study.
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