ABSTRACT
La dilatación precoz en esofagitis caústica no está bien establecida. Objetivo: Evaluar el beneficio de la dilatación precoz, en la evolución y complicaciones de esofagitis caústicas grado II y III. Pacientes y Métodos: Estudio prospectivo de 32 niños, grupo A (dilatación precoz) y B (dilatación tardía). Se utilizo el índice de dilatación periódica para evaluar beneficio de la dilatación precoz. Resultados: edad promedio 2,3 años; 13 (40,62%) hembras y 19 (59,38%) varones; 21/32 (65,62%) desarrollaron estenosis esofágica, 6/15 (40,00%) grupo A, 15/17 (88,23%) grupo B (p=0,0041). Estenosis simples en 12/21 (57,14%), complejas 9/21 (42,85%), recurrentes 2/6 y refractaria 2/6, grupo A; 6/15 recurrente y 5/15 refractarias, 1/15 perforación esofágica, grupo B. El promedio de sesiones de dilatación 17 vs 44,6 (p=0,0297) e índice de dilatación periódica de 3,04 vs 4,11 (p=0.0002) grupo A y B respectivamente. Conclusiones: la dilatación precoz en esofagitis caústica es segura y contribuye a disminuir el número de sesiones de dilatación y complicaciones. Se destaca, la importancia de la prevención de la ingesta accidental de cáusticos.
Early dilatation in caustic esophagitis is not well established. Objective: Evaluate the benefits of early dilatation in the evolution and complications of grade I and II caustic esophagitis in children. Patients and Methods: Prospective study of 32 children, group A (early dilatation) and B (late dilatation). The periodic dilatation index was used to evaluate the benefits of early dilatation. Results: Average age 2,3 years old; 13 (40,62%) female and 19 (59,38%) male; 21/32 (65,62%) developed esophageal stenosis. 6/15 (40,00%) group A, 15/17 (88,23%) group B (p=0,0041). Simple stenosis in 12/21 (57,14%), complex 9/21 (42,85%), recurrent 2/6 and refractory 2/6, group A; 6/15 recurrent and 5/15 refractory, 1/15 esophageal perforation, group B. The average of dilatation sessions was 17 vs. 44,6 (p=0,0297) and periodic dilatation index was 3,04 vs. 4,11 (p=0.0002) group A and B respectively. Conclusions: early dilatation in caustic esophagitis is safe and contributes to decrease the number of dilatation sessions and complications.
Subject(s)
Humans , Male , Female , Child , Gastric Dilatation/complications , Esophagitis/diagnosis , Esophagitis/pathology , Esophageal Stenosis/complications , Gastroenterology , PediatricsABSTRACT
PURPOSE: There have been many accidental ingestions of strong acid or alkali in early childhood. If the patient survives the acute effects of caustic ingestion, the reparative response can result in esophageal and gastric stenosis. However there have been few endoscopic studies on caustic esophagitis in children. The aim of this study was to review the contribution of the endoscopy to the diagnosis and management of eosphageal stricture and to search for the guidline of the proper management. METHODS: We carried out the retrospective study on 15 children who admitted to Seoul National University Children's Hospital after accidental ingestion of caustic agents from the March 1990 to July 1995. They all underwent flexible gastrofiberoscopy to predict the complication of the caustic esophagitis. RESULTS: The early gastrofiberoscopy showed that the 2nd degree esophageal injury was most common and the majority of patients had diffuse, not localized esophagitis. The incidence of the late occurance of the esophageal stenosis was higher in patients who showed more severe degree of the esophageal mucosal damage on the early endoscopic examination. After the detection of esophageal stenosis on follow up esophagographic examination, 7 children were initially managed with balloon dilatation : Only 2 of them were successfully treated and 5 of them showed poor response to dilatation and finally treated with surgical correction. One child was successfully treated with surgical correction without trial of esophageal balloon dilatation. One child with mild esophageal stenosis improved clinically with supportive care only including antibiotics, steroid therapy, hyperalimentation etc. CONCLUSIONS: The early gastrofiberoscopic examination immediately after the accident is essential for predicting the late occurance of the esophageal stenosis. Esophageal stenosis could be successfully treated with esophageal balloon dilatation and/or surgical correction with caustic esophagitis in childtren.