GUIDEWIRE-ASSISTED ESOPHAGEAL BOUGIENAGE IN SEVERE CHEMICAL BURNS IN CHILDREN: CLINICAL EFFECTIVENESS OF THE...

Corrosive esophageal burns in children remain a clinically important problem because they frequently result in cicatricial strictures, persistent dysphagia, nutritional impairment, and the need for staged treatment. The greatest challenges occur in severe (grade III) injuries, where conventional blind bougienage is performed without visual control and carries a risk of additional esophageal trauma.

To compare the effectiveness and safety of endoscopically controlled guidewire-assisted bougienage with traditional treatment approaches in children with cicatricial strictures after grade III corrosive esophageal burns.

This retrospective single-center cohort study with a historical control included 148 children aged 5-14 years. The main group comprised 102 patients who underwent guidewire-assisted esophageal dilation under endoscopic control during 2019-2023. The control group included 46 patients treated with conventional methods (blind bougienage and/or gastrostomy followed by string-guided bougienage) during 2015-2018. The primary endpoint was defined as the short-term clinical success of dilation - restoration of oral feeding (per os) without gastrostomy during the index hospitalization, i.e., a short-term in-hospital outcome. In addition, the frequency of gastrostomy, length of hospital stay, and complication rates were assessed; infectious complications were defined as documented nosocomial infectious events requiring medical intervention. For the comparative analysis, RR, OR, 95% CI, ARR, and NNT were calculated.

Clinical success was achieved in 94/102 children in the main group (92.2%; 95% CI 85.3-96.0) versus 21/46 in the control group (45.7%; 95% CI 32.2-59.8) (RR 2.02; 95% CI 1.47-2.78; OR 13.99; 95% CI 5.54-35.32; p < 0.001). The absolute difference was 46.5% (NNT=3). The need for gastrostomy was markedly lower with endoscopically controlled dilation: 7.8% vs 54.3% (RR 0.14; 95% CI 0.07-0.30; p < 0.001). Median length of stay was 12 [9-16] days in the main group and 19 [14-25] days in the control group (p<0.001). Complications were also less frequent in the main group: 5.9% vs 17.4% (RR 0.34; 95% CI 0.12-0.92; p=0.036).

In children with post-burn cicatricial esophageal strictures after grade III corrosive injury, endoscopically controlled guidewire-assisted bougienage is associated with better short-term in-hospital outcomes than conventional management, including higher dilation success, reduced need for gastrostomy, shorter hospitalization, and fewer complications. Prospective multicenter studies with long-term follow-up are warranted to confirm these findings.