Corrosive Esophageal Stricture Research Articles

Pharyngo-colonic anastomosis for esophageal reconstruction in the treatment of diffuse corrosive esophageal stricture

To observe the experience and the outcome of pharyngo-colonic anastomosis for esophageal reconstruction in diffuse corrosive esophageal stricture involving hypopharynx. This retrospective report reviews the experience and results of 14 patients who underwent esophageal reconstruction by pharyngo-colonic anastomosis without resection of intra thoracic stricture esophagus. The left half colonic segment was pulled up to the neck through the substernal space in all patients. There was no operative or hospital death. Postoperative complications include cervical anastomotic fistula in four patients, rupture of the abdominal incision in 1. The length of follow-up ranged from half year to 10 years with an average of 4 years. Anastomotic stenosis occurred in 2 patients. One case improved after dilatation and the other one healed by plastic operation. One patient began to vomit after diet in seven months later with barium swallowing the abdominal colon graft was redundant and this patient was cured with side by side between the colon and the stomach. The successful reconstruction for hypo-pharyngo-esophageal stricture requires a correct and larger hypopharyngeal opening and a good anastomotic technique. From our experience this procedure is shown to be safe and effective.

Corrosive Oesophageal Stricture: A Preventable Scourge

Aim: This study aims to determine the nature and circumstances surrounding the ingestion of corrosive substances that resulted in oesophageal strictures among patients attending the University of Nigeria Teaching Hospital, Enugu. This is with a view to highlighting that corrosive oesophageal stricture is preventable. Methodology: A retrospective study of U.N.T.H. patients managed for corrosive oesophageal stricture between 1991 and 2001 was done using information extracted from their case records. Result: Sixty-nine eligible cases were seen out of which 33 records were retrieved. All ages and sexes were involved with youths and children topping the list. Caustic soda was involved in 12 patients, 7 patients drank acid and 14 were involved with other chemicals including drugs from “chemist” shop, native medicine etc. Twenty-six (26) were accidental, 4 were suicidal attempt and 3 attributed their problem to ingestion of medication. Thirty-two (32) had gastrostomy and subsequent colon transplant to replace the oesophagus. Duration of treatment and hospital admission was 4 months on the average. Conclusion: Since most cases of oesophageal stricture due to ingestion of corrosives occurred as a result of accidental ingestion, this problem and its costly consequences are preventable. Key Words: Corrosive Ingestion, Oesophagus, Scourge Complex, Preventable Orient Journal of Medicine Vol.15(3&4) 2003: 8-11

Pharyngo-enteral anastomosis for esophageal reconstruction in diffuse corrosive esophageal stricture

Background. Diseases involving the entire esophagus usually require extensive surgical procedures to accomplish functional reconstruction. These procedures are extremely stressful for undernourished patients. We have utilized a simpler procedure for total esophageal reconstruction. Methods. This retrospective report reviews the experience in 8 patients who underwent esophageal reconstruction by pharyngo-colo-gastrostomy or jejunostomy without any resection of bony structures. Results. There was no operative or hospital death. Complications included anastomotic stenosis, transient leak from the ileal stump, and late enterocutaneous fistula, each in 1 patient. Laryngeal function was maintained without special treatments. After swallowing training for approximately 1 week, oral feeding was resumed. All patients have gained 7 to 21 kg at 35 to 67 months after surgery. Conclusions. Our surgical procedure is shown to be safe and effective in undernourished patients with diffuse esophageal stricture.

Is it necessary to resect the diseased esophagus in performing reconstruction for corrosive esophageal stricture?

The incidence of carcinoma of the esophagus among patients with chronic esophageal stricture caused by ingestion of corrosive agents is reported to be significantly higher than that of the general population. The question of whether or not a resection of the diseased esophagus should be included in the surgical reconstruction procedure of the undilatable esophageal stricture continues to be a controversial. During the 12 year period from 1988 to 1999, a total of 54 consecutive patients with caustic stricture of the esophagus were treated in our department. We retrospectively reviewed these cases and analyzed the incidence of cicatrical carcinoma among the patients and the risk of esophagectomy according to the procedures performed. We found seven cases of esophageal cancer among these patients. There was no significant increase in mortality or morbidity related to esophagectomy. Considering the high incidence of cicatrical carcinoma from the stricture sites as well as the possible chance of hidden malignancy, we concluded that the simultaneous resection of the esophagus with reconstruction for patients with chronic intractable caustic stricture would give the patients a better probability of being completely cured of the disease.

Redoing reconstruction of the esophagus using remnants of the ileo-left colon aided by microvascular anastomosis

Theoretically, the jejunum, fasciocutaneous or myocutaneous flap is recommended as an esophageal substitute in redoing reconstruction of the esophagus after a second incidence of corrosive injury. However, other esophageal substitutes should also be considered. We present a case of a 42-year-old woman who underwent esophageal reconstruction using an ileocolon graft for corrosive esophageal stricture ten years before. The patient ingested caustic drain cleaner again and underwent resection of the ileocolon graft secondary to corrosive necrosis. Two and a half months after the second incidence of corrosive injury, reconstruction of the esophagus was again performed using a graft of remnant ileo-left colon aided by microvascular anastomosis. The patient was able to swallow a regular diet after the procedure. Remnant ileo-left colon is a good alternative esophageal substitute in cases of repeated corrosive injury.

Intralesional steroids augment the effects of endoscopic dilation in corrosive esophageal strictures

Background: Intralesional corticosteroid injection has been shown to be effective in refractory esophageal strictures of various etiologies. The present study was conducted to determine the efficacy of intralesional triamcinolone in augmenting results of endoscopic dilation in corrosive esophageal strictures. Methods: Seventeen patients with corrosive esophageal strictures were treated with endoscopic dilation together with injection of triamcinolone acetonide into the stricture. Fourteen patients were already undergoing dilation; 3 patients were newly recruited. The interval between dilations and frequency of dilation were calculated before and after corticosteroid injections, and periodic dilation index was calculated as number of dilations/number of months. Results: The mean age of the 17 patients (8 men and 9 women) was 30 ± 9.21 (range 13 to 52). Thirteen had strictures due to acid ingestion, four to alkali ingestion. There were 18 strictures in total, involving the upper (n = 2), middle (n = 10), and lower (n = 6) thirds of esophagus. Fourteen patients already on a dilation program had undergone 27.92 ± 28.63 (range 6 to 92) dilations over a period of 22.92 ± 30.73 months (range 2 to 96) before corticosteroid injections. Nine patients received a single injection of triamcinolone, whereas four each had two and three sessions. The dilation requirement after injections in these 14 patients was reduced to 3.57 ± 2.90 (range 0 to 10) dilations over a period of 10.5 ± 5.58 (range 4 to 21) months. The median total periodic dilation index irrespective of corticosteroid therapy was 0.33 (range 0.55 to 1.8). In 12 of the 14 patients, periodic dilation index before injections (range 0.91 to 3.0, median 1.67) was higher than the median total periodic dilation index and in all the 14 patients periodic dilation index after corticosteroid therapy (range 0 to 0.83, median 0.32) was less than the median of total periodic dilation index ( p < 0.01). In addition three patients received intralesional corticosteroid injections at the time of first dilation. These three patients could be effectively dilated with 5, 3, and 3 dilations. Conclusions: Intralesional triamcinolone injections augment the effects of endoscopic dilation in patients with corrosive esophageal strictures. (Gastrointest Endosc 1999;49:509-13.)

Gastric transposition for esophageal replacement in children--an Indian experience.

Most pediatric surgeons are wary of gastric transposition as a means for esophageal replacement in children, especially during infancy. We present our initial experience of this technique in five children followed up for an average 1.7 years postoperatively. Four of them were infants (age range 5 m to 10 m at the time of transposition) with wide-gap esophageal atresia, while one was operated upon for an extensive corrosive esophageal stricture at 4 years age. The stomach was placed transhiatally in 3 patients and through the retrosternal route in 2 patients. A gastric outlet drainage procedure was performed in all cases. The average age at transposition in the 4 infants with esophageal atresia was 8.5 months and the mean weight was 7.4 kg. Three of the four infants required postoperative ventilation (mean duration 40 hours) and the average duration of hospital stay was 24 days. Our first transposition in a chubby infant resulted in death (20% mortality for this series) due to difficult ventilation. Other complications included anastomotic leak and subsequent stricture (one patient), adhesive obstruction (one patient), transient Horner's syndrome and recurrent laryngeal nerve palsy (one patient), and poor weight gain (one patient). Postoperatively, while the pattern of liquid gastric emptying was variable, no duodenogastric reflux was demonstrable. Thus gastric transposition is a safe, relatively simple and physiologic procedure in infancy and childhood and has given good functional results.

Surgical Treatment of Acid Induced Corrosive Esophageal Stricture in Children

Surgical Treatment of Acid Induced Corrosive Esophageal Stricture in Children

Treatment of corrosive esophageal strictures by long-term stenting

From 1975 through 1992, 932 patients with caustic esophageal burns were admitted to the author's institution. Deep circumferential burns were diagnosed esophagoscopically in 241 children within the first 48 hours postburn. Initial treatment consisted of periodic anterograde and/or retrograde dilations of the injured and scarring esophagus (n = 172). In 1989, a long-term stenting technique was introduced, and a total of 69 patients have been treated in this manner. The healing rates of patients treated with traditional therapy were compared with those of patients who had stenting, and a significant difference was noted (33% v 68%; P < .01). Failure among the stented group was attributable to poor patient compliance and to gastroesophageal reflux resulting from shortening of the esophagus during scar formation.

Corrosive esophageal strictures: Predictors of response to endoscopic dilation

Twenty-one patients with corrosive esophageal strictures underwent contrast-enhanced CT of the chest to determine (1) the esophageal wall thickness at the stricture site and (2) its correlation with number of sessions required for adequate dilation. Average esophageal wall thickness was defined as the mean thickness of all four walls at the site of the stricture, whereas the size of the thickest wall was taken as maximal esophageal wall thickness. Average esophageal wall thickness (8.52 ± 0.61 mm; range, 5.4 to 13.5 mm) and maximal esophageal wall thickness (11.63 ± 0.83 mm; range, 5.4 to 20 mm) were significantly higher in patients with corrosive esophageal strictures than normal esophageal wall thickness (2.70 ± 0.04 mm, p < .01). These patients required a mean of 5.70 ± 1.42 sessions for achieving adequate dilation. Age, sex, grade of dysphagia, and cause and site of the stricture did not influence the number of sessions required for adequate dilation. On multivariate analysis, maximal esophageal wall thickness ( p < .01) but not average esophageal wall thickness or stricture length was independently associated with the number of sessions required for adequate dilation. Patients with maximal esophageal wall thickness of 9 mm or more required a significantly higher number of sessions for adequate dilation than did those with wall thickness of less than 9 mm (7.57 ± 1.80 versus 1.42 ± 0.27, p < .05). These observations suggest that (1) marked esophageal wall thickening occurs in patients with corrosive esophageal strictures, and (2) maximal esophageal wall thickness can be helpful in predicting the response to endoscopic dilation. (Gastrointest Endosc 1995;41:196-200.)

Histopathologic Studies of Gastric Mucosa following Gastric Substitution in Benign and Malignant Esophageal Disease

Gastric interposition was performed and prospectively studied in 9 patients with esophageal cancer, 1 patient with esophageal neurofibroma and 5 with corrosive esophageal stricture. The postoperative follow-up periods were between 6 to 68 months with a mean of 28.6 months. The subjects were then endoscopically reviewed. Twelve of them were macroscopically normal. The others exhibited signs of inflammation and hyperemia. Mucosal biopsies were obtained at the upper and lower third of the graft. The histologic findings were compared with those of the preoperative specimens. Among the 15 post-operative specimens, only minute histologic changes were seen. Three patients whose proximal grafts showed inflammatory signs revealed congestion. Another 2 patients exhibited granulocyte infiltration in the mucosa of the distal third. The mucosal structure of the remaining 10 patients was similar to that of the preoperative graft. In conclusion, the macroscopic and microscopic changes were few and minimal although there were alterations in function, physiology and location of the stomach.

Long term results of endoscopic dilatation for corrosive oesophageal strictures.

Although dilatation is the treatment of choice for most patients with benign oesophageal strictures, there is little information on its efficacy and safety in corrosive oesophageal strictures. Of 123 adults with benign oesophageal strictures treated by endoscopic dilatation, 52 (42.3%) had strictures after corrosive ingestion and 39 (31.7%) had peptic strictures. Treatment was considered adequate if the oesophageal lumen could be dilated to 15 mm and there was complete relief of dysphagia. If dysphagia recurred after adequate initial dilatation, the stricture was dilated again up to 15 mm. Initial dilatation was adequate in 93.6% of patients with corrosive strictures and this success rate was comparable with that of the peptic stricture group (100%, p > 0.05). Long term success after adequate initial dilatation was studied in 36 patients with corrosive strictures (mean follow up 32.36 (17.12) months, range 6-60) and 33 patients with peptic strictures (mean follow up 36.32 (17.9) months, range 6-60). The mean (SEM) number of symptomatic recurrences per patient month during the total follow up period in the corrosive group was significantly higher than that in the peptic group (0.27 (0.04) v 0.07 (0.02), p < 0.001). The recurrence rate in the corrosive group, however, decreased over time, and after 12 months it was significantly (p < 0.001) lower than the recurrence rate in the first six months. After 36 months, the difference in the recurrence rate in the two groups was not significant (p > 0.05). Only nine oesophageal perforations occurred during a total of 1373 dilatation treatments (procedure related incidence 0.66%), and eight of these were in the corrosive stricture group. These patients were managed conservatively and subsequently strictures were dilated adequately in all. Endoscopic dilatation is safe and effective for short and long term relief of dysphagia in patients with corrosive oesophageal strictures.

Conservative treatment of corrosive esophageal strictures: A comparative study of endoscopic dilatations and esophageal stenting : F. De Peppo, M. Rivosecchi, G. Federici, et al. Pediatr Surg Int 8:2–7, (January), 1983

Conservative treatment of corrosive esophageal strictures: A comparative study of endoscopic dilatations and esophageal stenting : F. De Peppo, M. Rivosecchi, G. Federici, et al. Pediatr Surg Int 8:2–7, (January), 1983

Difficulty of balloon dilatation in corrosive esophageal strictures

Difficulty of balloon dilatation in corrosive esophageal strictures

Conservative treatment of corrosive esophageal strictures: A comparative study of endoscopic dilatations and esophageal stenting

From 1982 to 1990, 222 children (mean age 2.5 years, range 1–11 years) were admitted to Bambino Gesu' Children's Hospital for suspected caustic ingestion. In 126 cases (56.7%) esophageal injuries were evidenced on endoscopy, which was always performed within 24 h of the injestion. Eighteen children (8.1%) developed an esophageal stricture; 4 of these were treated surgically and the remaining 14 were included in two different protocols of conservative treatment: up to 1987, 7 patients (group 1) underwent periodic esophageal dilatations; from 1988 to 1990, 7 (group 2) were treated by esophageal stenting. In group 1, a mean of 25.1 ± 17.8 months and 19.3 ± 15.8 dilatations were necessary for the stenosis to heal completely. In group 2, disappearance of the stricture was achieved within 12.8 ± 9 months with a mean of 9.4 ± 11 dilatations. Esophageal stenting appeared to reduce by half both the duration of treatment and the number of dilatations required to obtain complete healing of corrosive stenoses. Moreover, the scars softened after stent placement, allowing safer dilatation of recurrent strictures.

アルカリ服用による腐蝕性食道狭窄の1手術例

アルカリ服用による腐蝕性食道狭窄の1手術例

Corrosive esophageal stricture: safety and effectiveness of balloon dilation.

The safety and long-term effectiveness of fluoroscopically guided balloon dilation for corrosive esophageal stricture was evaluated in 22 patients with a follow-up period of more than 1 year (range, 13-52 months). The average interval between corrosive agent ingestion and initial balloon dilation was 18 years (range, 2 months to 51 years). Balloons with a diameter of 5-8 mm were used in the initial attempt. The caliber of the balloon catheter was increased gradually over subsequent dilations, up to a diameter that allowed patients to swallow solid foods. Dilation of more than 17 mm in diameter was performed in five patients. Patients underwent one to five sessions. Esophageal rupture occurred in seven patients and was treated nonoperatively in five and surgically in two. With exclusion of these latter two, 11 of 20 could tolerate swallowing all kinds of food and nine could tolerate swallowing most foods. Balloon dilation in corrosive esophageal strictures is effective, but the high rupture rate indicates the need for extra caution.

Persistence of corrosive esophageal stricture due to gastroesophageal reflux in children

Four children with severe corrosive esophageal strictures persisting despite repeated dilatations are presented. These resistant stenoses are believed to be secondary to gastroesophageal reflux, which causes peptic esophagitis, perpetuating the esophageal stricture. Attempts at conservative management were not successful. In all four patients an anti-reflux procedure (Nissen) resulted in cure of the stenosis.

Cerebral abscess complicating dilatation of a corrosive esophageal stricture

A case is presented in which a metastatic cerebral abscess developed in a 62-year-old female who required repeated dilatation for an esophageal stricture following accidental ingestion of liquid caustic soda. The literature is reviewed and management suggested for the avoidance of this uncommon complication.

Indomethacin for prevention of stricture formation due to alkali-induced corrosive esophageal burns in the rat

The aim of this study was to investigate the therapeutic effect of indomethacin on corrosive esophageal strictures. Esophageal burns were produced in 40 of 50 Sprague-Dawley rats by 10.7% NaOH and were then grouped as pure esophageal burns, esophageal burns treated with indomethacin, and controls. All of the animals were killed on the 28th day of the experiment and hydroxyproline levels in esophageal tissue were determined for each rat. Hydroxyproline levels were significantly lower in the indomethacin-treated group than in the other two groups. Based on our results, we suggest that indomethacin inhibited collagen synthesis and thus alkali-induced esophageal stricture formation.