Outcomes of the management of corrosive injuries of the upper digestive tract in a tertiary care center

Summary Esophageal stricture is the most common delayed sequelae of aerodigestive tract corrosive injuries. Early endoscopic dilatation is an integral part of corrosive injury management. Self-dilatation of the esophagus is effective in preventing stricture recurrence. In this prospective study, we included patients with corrosive aerodigestive tract injury from January 2009 to December 2020. We analyzed the outcome of the endoscopic dilatation and self-dilatation treatments administered to patients with a corrosive esophageal stricture. Among 295 patients, 164 had an esophageal injury, 73 had esophago-gastric injury, 55 had a gastric injury, and 3 had the pharyngeal injury. Of the 295 patients, 194 (81.85%) underwent dilatation, and 13 patients with diffuse esophageal injury underwent upfront surgery. Successful dilatation was performed in 169 (87.11%) patients. Of the 68 patients undergoing self-dilatation, 63 patients achieved nutritional autonomy by 28 days. Early endoscopic dilatation effectively prevents surgery, and self-dilatation appears promising to prevent recurrent esophageal stricture.

Acute Management in Corrosive Ingestion

Corrosive ingestion is an important health problem and medical emergency worldwide. It occurs by accident or by intention. Acids cause coagulation necrosis, and alkalis cause liquefaction necrosis. In the acute period, stabilization of the patient is most important. Airway assessment and prompt management are a priority for severe cases. Caustic substance reflux into the esophagus resulting in further damage should be prevented. The initial evaluation should be performed by endoscopy and graded according to the Zargar classification. Computed tomography (CT) should be used to assess injury to the esophagus because CT is non-invasive. For Zargar 3b injuries, views from both endoscopy and CT scans should be considered. Post-corrosive esophageal stricture is a complication that responds poorly to treatment. Research and development for stricture prevention are ongoing, especially for Zargar 2b and 3a cases.

Successful Esophageal Replacement Surgery in a 3-Year Old with Post-corrosive Esophageal Stricture

Accidental caustic ingestion in children, though entirely preventable, continues to be present in developing countries. Gastrointestinal injuries following caustic ingestion in children range from mild to fatal. Presentation of such children to the medical facility could be early or sometimes late with complications. Management is based on the type of injury and could range from medical conservative management to complex surgical procedures. Such complex surgeries are almost unavailable in developing countries. We present a 3-year old who presented to our facility with an esophageal stricture following accidental caustic ingestion four months prior to presentation. He had a failed stricture dilatation and needed to be managed surgically; he subsequently had a good outcome, which is rare in developing countries. Keywords: Post-corrosive esophageal stricture, Esophageal replacement surgery

Surgical treatment of acquired tracheoesophageal fistula caused by balloon dilatation of corrosive esophageal stricture in a child

Introduction. Tracheoesophageal fistula (TEF) as a complication of balloon dilatation (BD) of corrosive esophageal stricture is a very rare and serious condition. Life threatening aspiration pneumonia requests urgent lungs' protection, but overall treatment strategy is not clearly defined. Case report. Twenty-month-old female child accidentally ingested a household bleach. Caustic injury of esophagus was healing with development of strictures of cervical and proximal thoracic esophagus. TEF was developed during the third BD. Healing of TEF and pulmonary infection was achieved by exclusion of the esophagus (pharyngostoma and feeding gastrostomy together) with prolonged tracheobronchial intubation and toilette. Retrosternal colon interposition was performed a year later, with excellent functional results over four-year follow-up. Conclusion. Esophageal exclusion in the first stage, and pharyngoesophageal reconstruction in the second stage, is a useful therapeutic option in the treatment of TEF caused by balloon dilatation of corrosive esophageal stricture in children.

Transnasal Esophageal Stricture Dilatation using Savary–Gilliard Dilator System—A Novel Approach

Transnasal esophagoscopy is office-based procedure, used by otolarynologists and gastroenterologists for evaluation of dysphagia, odynophagia, esophageal stricture dilatations, and other numerous indications. Through the scope (TTS) balloon dilatation using ultrathin gastroscope is routine practice in patients with esophageal stricture (ES). Here, we are highlighting a case of post corrosive esophageal stricture with inadequate mouth opening dilated using savary gilliard (SG) dilator system transnasally.