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Conservative treatment of caustic esophageal strictures in children
H Z Gündoğdu1, F C Tanyel, N Büyükpamukçu
1Department of Pediatric Surgery, Hacettepe University Children's Hospital, Ankara, Turkey.
Insights
Most pediatric esophageal strictures from corrosive ingestion can be treated conservatively. Successful outcomes are more likely in younger children and specific types of strictures, though long-term dilation may be needed.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Toxicology
Background:
- Caustic esophageal strictures are a common pediatric surgical issue, often resulting from accidental ingestion of corrosive agents.
- Delayed treatment can lead to prolonged hospitalization and significant morbidity.
Purpose of the Study:
- To evaluate the effectiveness and predictors of successful conservative management for caustic esophageal strictures in children.
- To identify factors influencing the duration and success of non-surgical treatment.
Main Methods:
- Retrospective clinical study of 202 pediatric patients diagnosed with caustic esophageal strictures between 1976 and 1989.
- Analysis of patient demographics, ingested agents, stricture characteristics, and treatment outcomes.
Main Results:
- Conservative treatment, primarily periodic dilations, was successful in most cases, although 50.7% required over a year of treatment.
- Success rates were higher for patients younger than 8 years, strictures from non-lye caustics, upper esophageal involvement, and shorter stricture length (<5 cm).
Conclusions:
- Conservative management is the primary approach for pediatric caustic esophageal strictures.
- Age, causative agent, and stricture location/length are key predictors for successful conservative treatment outcomes.
Abstract:
The most common cause of esophageal stricture in children is the accidental ingestion of strong corrosive agents. During a 13-year period between 1976 and 1989, 202 patients were diagnosed as having caustic esophageal strictures at the Hacettepe University Children's Hospital Department of Pediatric Surgery. A retrospective clinical study was performed to find out the place and predictors of a successful outcome for conservative treatment in children who have caustic esophageal strictures. Two hundred two children, of whom 145 were male (71.7%) and 57 female (28.3%) with 168 (83.2%) being younger than 6 years of age, were evaluated retrospectively. Whereas only 49.3% of patients could be treated within a 12-month period, 50.7% needed more than 1 year, 32.9% needed more than 2 years, 26.7% needed more than 3 years, and 15.4% needed more than 4 years of periodic dilations in order to become swallowers through native esophaguses. The success of conservative treatment has been higher in patients younger than 8 years of age, and in strictures due to caustics other than lye involving upper third portion and less than five cm of an esophageal segment. Most caustic esophageal strictures could have been treated by conservative measures in children.