Corrosive ingestion managements in children

Area of Science:

• Gastroenterology
• Toxicology
• Surgical Innovation

Background:

• Corrosive (caustic) material ingestion is a significant global health problem, especially in developing nations.
• Current management strategies, including endoscopic grading, prolonged NPO (nothing by mouth) status, and delayed barium studies, are suboptimal.
• There is a need for updated protocols to improve patient outcomes and reduce complications like esophageal strictures.

Purpose of the Study:

• To introduce and evaluate a new management protocol for corrosive ingestion.
• To demonstrate the efficacy of the DROOL score for predicting esophageal stricture risk.
• To advocate for earlier diagnosis and treatment of dysphagia and strictures.

Main Methods:

• Abandoning traditional management based on endoscopic grading, NPO, and barium studies.
• Utilizing the prognostic DROOL score (≤4) for accurate stricture prediction.
• Implementing early oral feeding upon saliva swallowing ability.
• Employing fluoro-endoscopic balloon-assisted esophageal examination for dysphagia diagnosis (10-14 days).
• Initiating early balloon dilation (18-20 mm) during the same anesthesia procedure.

Main Results:

• The DROOL score accurately predicts esophageal stricture development.
• Early oral feeding and timely intervention significantly reduce stricture formation.
• Fluoro-endoscopic examination diagnoses dysphagia earlier than barium studies.
• Early balloon dilation with large balloons demonstrates high safety and success rates.
• Esophagectomy is reserved for refractory cases.

Conclusions:

• A revised management protocol for corrosive ingestion offers improved outcomes.
• Early intervention, accurate risk stratification (DROOL score), and timely endoscopic procedures are key.
• The risk of esophageal carcinoma post-ingestion necessitates long-term surveillance.