Multiple benign strictures of the oesophagus in the paediatric age-group--modified technique of antegrade dilatation
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Accidental ingestion of corrosive substances causes esophageal strictures, especially in children. Jackson's antegrade dilatation offers a safe and effective method for managing these benign strictures, achieving lasting lumen patency.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Otolaryngology
Background:
- Benign esophageal strictures commonly result from accidental ingestion of strong acids and alkalis.
- Pediatric patients from lower socio-economic backgrounds are particularly vulnerable.
- Management typically involves repeated antegrade dilatations to gradually widen the esophageal lumen.
Observation:
- A novel observation during Jackson's antegrade dilatation involved the bougie being 'sucked down' the stricture.
- This phenomenon occurred spontaneously, facilitating passage through the narrowed esophageal segment.
- The technique was noted to be potentially safer than forceful dilation.
Findings:
- Ten cases of multiple, benign, permeable esophageal strictures were successfully managed using Jackson's antegrade dilatation.
- The observed 'sucking' technique became routine, with no mortality reported in the series.
- An average lumen of 6 mm (Jackson's bougie No. 18) was achieved and permanently maintained.
Implications:
- The modified Jackson's antegrade dilatation technique offers a safer alternative for managing benign esophageal strictures.
- This approach can lead to sustained esophageal lumen patency, improving patient outcomes.
- Further research into the mechanics and broader applicability of this 'sucking' dilatation method is warranted.
Abstract:
Accidental ingestion of strong acids and alkalines still remains the commonest cause of benign strictures of the oesophagus in our country, particularly in children from the poor socio-economic strata, who are left alone to fend for themselves. Once the stricture is well-formed, repeated antegrade dilatations are required in order to dilate the lumen gradually. The procedure is done with the utmost care and gentleness in order to avoid rupture of the cicatricial wall of the oesophagus. The present series consisting of 10 cases of multiple, benign, mostly permeable, strictures of the oesophagus were successfully managed with Jackson's antegrade dilatation technique. During one of the dilatation sessions we observed that instead of pushing the bougie gently, it seemed to be sucked down entirely on its own, a few millimeters at a time (described in case 3) and traversed the entire stricture. This procedure appears safer for the patient and has now become routine with us. There was no mortality in our series. In all, a total of 168 dilatations have been done. The average lumen achieved in all our cases was 6 mm (Jackson's bougie No. 18) which was well maintained in all our cases on a permanent basis.