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Corrosive oesophageal strictures in children: outcomes after timely or delayed dilatation
S Contini1, M Garatti, A Swarray-Deen
1Department of Surgical Sciences, School of Medicine & Dentistry, University of Parma, Italy. sandro.contini@unipr.it
Insights
Delayed dilatation of caustic oesophageal strictures in children leads to higher risks of perforation and recurrence. Timely intervention offers better clinical outcomes and fewer complications for pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Otolaryngology
- Emergency Medicine
Background:
- Caustic strictures are challenging benign esophageal lesions, particularly in low-income countries where pediatric patients often present late for treatment.
- Delayed presentation can lead to highly fibrotic strictures requiring intervention weeks after initial injury.
- Limited data exists on the outcomes of late dilatations for pediatric caustic esophageal injuries.
Purpose of the Study:
- To evaluate the safety and efficacy of late esophageal dilatation for caustic strictures in children.
- To compare outcomes of delayed treatment (>6 weeks) versus timely treatment (<6 weeks) in pediatric patients.
- To analyze complication and recurrence rates associated with different treatment timings.
Main Methods:
- A retrospective study of 78 children (<15 years) treated for alkaline caustic ingestion between December 2005 and May 2007.
- Patients were divided into two groups: late dilatation (>6 weeks post-ingestion) and timely dilatation (<6 weeks post-ingestion).
- Esophageal dilatation was primarily performed using Savary dilators, with data collected on clinical outcomes, complications, and recurrence.
Main Results:
- Severe strictures were present in all patients. Late dilatation (n=25) showed a 91.6% success rate but had higher procedure-related perforation (2.6%) and death (4.0%) rates, with frequent recurrence (72% once, 31.8% twice).
- Timely dilatation (n=31) achieved a 96.7% success rate with lower perforation (0.7%) and death (3.2%) rates, and less frequent recurrence (30% once, 3.3% twice).
- Follow-up periods were 11+/-2.5 months for late and 10+/-2.1 months for timely groups, respectively.
Conclusions:
- Delayed dilatation of pediatric caustic esophageal strictures is associated with increased risks of perforation and higher rates of stricture recurrence.
- Timely esophageal dilatation in children following caustic ingestion yields better clinical outcomes and a lower complication profile.
- Prompt medical attention and intervention are crucial for managing pediatric caustic esophageal injuries to minimize long-term morbidity.
Background And Study Aims:
Among benign oesophageal lesions, caustic strictures are the most difficult to dilate. In low-income countries, children suffering caustic oesophageal injury are frequently referred to the hospitals late, sometimes weeks after ingestion. Therefore, dilatation may be performed late and in highly fibrotic strictures. Reports about endoscopic and clinical outcome of such delayed dilatations are scanty. The aim of this study was to evaluate the safety and efficacy of late caustic stricture dilatations in children, comparing it with the results of timely dilatations, both performed at the Hospital of the Italian Non-Governmental Organization "Emergency" at Goderich, Sierra Leone.
Patients And Methods:
From December 2005 to May 2007, 78 children (<15 years) complaining alkaline caustic ingestion were submitted to oesophageal dilatation, mainly (97%) using Savary dilators. Two groups were identified: children (group 1) with a late treatment (>6 weeks, 37+/-12 weeks), having arrived to the hospital late after ingestion, and children (group 2) dilated timely, i.e. at <6 weeks (4+/-1.4 weeks) after injury.
Results:
Strictures were severe in all patients. Twenty-five children were dilated late after injury (6.4 dilatations/patient) with a follow-up of 11+/-2.5 months. A successful clinical outcome was observed in 91.6%. Four perforations (2.6% procedure-related) and one death (4.0%) were observed. Strictures recurred once in 72% of patients, twice in 31.8%. Thirty-one children were dilated timely (4.5 dilatations/patient) with a follow-up of 10+/-2.1 months and a clinical success rate of 96.7%. Procedure-related perforation rate was 0.7% with one death (3.2%). Stricture recurred once in 30% and twice in 3.3%.
Conclusions:
Delayed dilatation of caustic oesophageal strictures in children carries a higher risk of perforation and a higher recurrence rate.
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