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Procedural and Surgical Interventions for Esophageal Stricture Secondary to Caustic Ingestion in Children
Kelli N Patterson1, Tariku J Beyene1, Lindsay A Gil1
1Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
Insights
Caustic ingestion can lead to esophageal strictures in over 10% of pediatric cases, often requiring multiple dilations and surgeries. Early multidisciplinary care is crucial for managing these complex injuries.
Area of Science:
- Pediatric Gastroenterology
- Otolaryngology
- Surgical Outcomes
Background:
- Caustic ingestion poses a risk of esophageal injury and long-term stricture development in children.
- Optimal management strategies for pediatric caustic esophageal injury remain undefined.
- This study investigates the incidence and management of esophageal strictures post-caustic ingestion.
Purpose of the Study:
- To determine the incidence of esophageal stricture following caustic ingestion in pediatric patients.
- To quantify current procedural and operative management strategies for these strictures.
- To inform the development of best-practice treatment algorithms for pediatric caustic esophageal injury.
Main Methods:
- Utilized the Pediatric Health Information System (PHIS) database.
- Identified pediatric patients (0-18 years) with caustic ingestion (2007-2015) and subsequent esophageal stricture (until 2021).
- Analyzed procedural codes for esophagogastroduodenoscopy (EGD), dilation, gastrostomy, fundoplication, tracheostomy, and major esophageal surgery.
Main Results:
- 10.8% (171/1588) of pediatric patients developed esophageal strictures after caustic ingestion.
- Stricture management involved frequent interventions: 84.2% had ≥1 EGD, 80.7% had dilation (median 9), and 23.4% underwent major esophageal surgery.
- Major surgery occurred a median of 208 days post-ingestion, with 40.9% requiring gastrostomy tubes.
Conclusions:
- Pediatric esophageal strictures post-caustic ingestion frequently necessitate multiple procedures and potentially major surgery.
- Early, coordinated multidisciplinary care is recommended for affected children.
- Development of a standardized treatment algorithm is needed to optimize outcomes.
Background:
Esophageal injury after caustic ingestion can vary in severity and may result in significant long-term morbidity due to stricture development. The optimal management remains unknown. We aim to determine the incidence of esophageal stricture due to caustic ingestion and quantify current procedural and operative management strategies.
Methods:
The Pediatric Health Information System (PHIS) was utilized to identify patients 0-18 years old who experienced caustic ingestion from January 2007-September 2015 and developed subsequent esophageal stricture until December 2021. Post-injury procedural and operative management was identified utilizing ICD-9/10 procedure codes for esophagogastroduodenoscopy (EGD), esophageal dilation, gastrostomy tube placement, fundoplication, tracheostomy, and major esophageal surgery.
Results:
1,588 patients from 40 hospitals experienced caustic ingestion of which 56.6% were male, 32.5% non-Hispanic White, and the median age at time of injury was 2.2 years (IQR: 1.4,4.8). Median length of initial admission was 1.0 day (IQR: 1.0, 3.0). 171/1,588 (10.8%) developed esophageal stricture. Among those who developed stricture, 144 (84.2%) underwent at least 1 additional EGD, 138 (80.7%) underwent dilation, 70 (40.9%) underwent gastrostomy tube, 6 (3.5%) underwent fundoplication, 10 (5.8%) underwent tracheostomy, and 40 (23.4%) underwent major esophageal surgery. Patients underwent a median of 9 dilations (IQR 3, 20). Major surgery was performed at a median of 208 (IQR: 74, 480) days after caustic ingestion.
Conclusion:
Many patients with esophageal stricture after caustic ingestion will require multiple procedural interventions and potentially major surgery. These patients may benefit from early multi-disciplinary care coordination and the development of a best-practice treatment algorithm.
Level Of Evidence:
III.
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