Corrosive Stricture Research Articles

Imre József a magyar nyelőcsősebészet megalapitója

József Imre as a member of Surgical Clinic personnel of Szeged University spent several months at the surgical department of the world-known R. Belsey in Leeds in the 6th decade of the last century. After returning home he introduced such operations in the domestic surgical practice as the Belsey-Mark IV antireflux fundoplication, fundoplication combined with myotomy, diverticulectomy + myotomy in Zenker diverticula, the Belsey type long left colonic graft for replacement of esophageal corrosive strictures and the monofil suture of oesophagal anastomosis. He prepared Tygon prosthesis for palliative oesophagal intubation. J. Imre was the author of the oesophagus chapter in Imre Littman’s monography of surgery. A large number of oesophagus operations was performed in his professional life. He left a total body of work behind. Cut in stone, his exceptional personality is commemorated in the pantheon of Surgical Clinic at Szeged University.

Study of definitive surgical management of patients with corrosive stricture of upper gastrointestinal tract

Background: Corrosive injury of the oesophagus and stomach is a cause of major morbidity and mortality and is usually seen in the younger age group. Although definitive surgical procedures are available, there is a considerable debate on the timing of a definitive surgery and its electiveness. This study aims to document the benefits of elective surgery and the outcomes of various surgical procedures.Methods: A retrospective observational study of 25 cases of corrosive stricture of upper gastrointestinal tract who underwent definitive surgical procedure was conducted in the department of general surgery at the new civil hospital and government medical college, Surat during a period of 60 months from July 2014 to July 2019. Patients were followed up till a period of 6 months post definitive surgical procedure and were evaluated.Results: Out of 25 patients in our study subjected to definitive surgical procedure in the form of either gastrojejunostomy (GJ) or colonic transposition, 18 patients (72%) could take fully oral and required no further intervention till 6 months post-operative follow up; 3 patients (12%) due to post-operative oesophageal stricture required serial 3 monthly oesophageal dilatation with controlled radial expansion (CRE) balloon; 4 patients (16%) had expired.Conclusions: The choice of definitive surgical procedure according to the level of oesophageal stricture and its optimal timing gives good outcomes with less morbidity and mortality in patients with corrosive substance ingestion.

Can high-frequency mini-probe endoscopic ultrasonography predict outcome of endoscopic dilation in patients with benign esophageal strictures?

Background and study aims Endoscopic dilation is first-line management for benign esophageal strictures (ES). Depth of involvement of the esophageal wall on endosonography using high frequency mini-probe (EUS-M) may predict response to dilation. This study evaluated EUS-M characteristics to predict response of ES to endoscopic dilation. Patients and methods EUS-M was used to measure the total esophageal wall thickness (EWT), involved EWT, percentage of involved wall and layers of wall involved in consecutive patients of benign ES. After a maximum of five sessions of endoscopic dilation, the cohort was divided into responders and refractory strictures. EUS-M characteristics were compared for underlying etiology as also between responders and refractory strictures. Results Of the 30 strictures (17 females, age: 47.16 ± 15.86 yrs.) 13 were anastomotic, eight corrosive, seven peptic and 2 others. Corrosive strictures had the highest involved EWT and percentage of involved wall (3.51 ± 1.36 mm; 76.38 %) followed by anastomotic (2.73 ± 1.7 mm; 65.54 %) and peptic (1.39 ± 0.62 mm; 40.71 %) ( P = 0.026 and 0.021 respectively). After five dilations, 22 were classified as responders and eight as refractory. Wall involvement > 70 % had a greater proportion of refractory strictures ( P = 0.019). Strictures with involved EWT of ≥ 2.85 mm required more dilations ( P = 0.011). Fewer dilations were required for stricture resolution with only mucosal involvement compared to deeper involvement such as submucosa and muscularis propria (2.14 vs. 5.80; P = 0.001). Conclusion EUS-M evaluation shows that corrosive and anastomotic strictures have greater depth of involvement compared to peptic strictures. Depth of esophageal wall involvement in a stricture predicts response to dilation.

423 OUTCOME OF LAPAROSCOPIC SURGERY FOR THE MANAGEMENT OF CORROSIVE STRICTURE OF THE OESOPHAGUS

Abstract The surgical treatment for a corrosive stricture of the oesophagus, after failed endoscopic dilatation, often involves oesophageal replacement using a gastric or a colonic conduit. This is traditionally done via the conventional open approach. The objective of this study was to ascertain short and long term outcomes of Laparoscopic gastric (LGP) and colon pull up (LCP) for the treatment of corrosive stricture of the oesophagus Methods Retrospective study of patients of corrosive oesophageal stricture, who, following a failed endoscopic dilatation, underwent a laparoscopic gastric or colon pullup between Jan 2011 and November 2019. All patients were evaluated with an upper endoscopy/contrast study to determine upper level and extent of stricture. Stomach was the preferred conduit, colon was used when either stomach was involved in the scarring process or in high pharyngeal strictures. Early and late postoperative outcomes were ascertained. Results During the study period, 254 patients with corrosive stricture oesophagus were managed surgically. Of these 50 underwent LGP and 10 underwent a LCP and these formed the study group. Mean age was 22.4 (2–42) years. The mean operative time (174.6 ± 43 and 322 ± 63 min) and blood loss (58.6 ± 23.9 and 108 ± 30.8 mL) for LGP and LCP respectively. Four patients developed mild respiratory infection. Eight patients developed cervical anastomotic leak. One patient had a colojejunal leak and another leak from the gastric tube staple line which was managed with drainage and antibiotics. At a mean followup of 51 months all patients were euphagic. Conclusion Laparoscopic surgery for corrosive strictures of oesophagus is safe and provides good short and long term outcomes.

176 SURGICAL MANAGEMENT OF CORROSIVE INJURIES OF ESOPHAGUS AND STOMACH—A 5 YEAR SINGLE CENTER EXPERIENCE

Abstract Corrosive injuries to the upper aero-digestive tract are a frequent cause of morbidity in India. We report here our institution's last 5-year experience in surgical management of corrosive injuries of oesophagus and stomach. Methods The aim of this study was to analyze the circumstance, demographic features, clinical findings and complications of caustic ingestion, the various surgical procedures performed and their short and long term outcomes. The records of 20 patients who underwent surgery for corrosive injuries of the oesophagus and stomach in our institution over a 5-year period (Jan2015-Dec2019) were retrospectively analyzed. Results Of 20 patients 13(65%) were accidental and 7(35%) were suicidal. Median age was 31 years with 75%males & 25%females. Presenting complaints were weight-loss(95%), dysphagia(65%) & vomiting(50%). Distributions of strictures were oesophageal, gastric or combined. 70% (N = 14) underwent feeding jejunostomy(FJ) as initial procedure. Isolated oesophageal strictures were managed by dilatation followed by gastric-pull through(N = 4)/coloplasty(N = 2). Isolated gastric strictures were managed Antrectomy (N = 5), distal/total gastrectomy (N = 2). Combined strictures were managed with coloplasty with antrectomy and Billroth I (N = 3) or coloplasty with Colo-jejunal anastomosis (N = 1). One patient underwent emergency esophagogastrectomy+cervical-oesophagostomy for perforation. Mortality rate was 15%(3/20). Conclusion Management of corrosive strictures varied between individual patients requiring a injury based surgery. Extensive injury with perforation, peritonitis or mediastinitis needed emergency surgery but associated with high mortality. Dilatation frequently failed in long segment strictures. High pharyngeal strictures were associated with higher morbidity. Isolated gastric strictures were easiest to manage. Corrosive strictures of oesophagus and stomach are difficult to manage and surgery has to be tailored according to site and extent of oesophageal/gastric stricture.

Two-Point Fixation Technique in Retrosternal Midcolon Interposition for Corrosive Stricture of Esophagus-Our Experience With 25 Patients.

Background. In 1911, Vuillet and Kelling independently described the anatomical and surgical bases of esophageal replacement with the colon. An important complication, in particular in later follow-up, is redundancy of the interposed colon, seen more after retrosternal interposition. The best treatment is prevention by a meticulous surgical technique and measurement of the length of the colon needed to replace the esophagus. Methods. This was a retrospective study of innovative surgical technique. A total of 25 patients with corrosive stricture of the esophagus undergoing two-point fixation in retrosternal colon interposition were included in the study. Preventive Operative Technique. After straightening of conduit by pulling very delicately over both sides, first fixation point we considered cervical anastomoses and second fixation point was made in subxiphoid space, taking two seromuscular stiches from the antimesenteric border of the colon to falciform ligament situated on the right side of the conduit. Results. There were 07 male and 18 female patients with M:F was 1:2.5; mean age was 29years (range: 23-45years) and mean hospital stay was 14days (range: 10-23days). In this study, we did not encounter any subjective or objective evidence of redundancy in any patients in follow-up barium swallow after 2.5years of follow-up. Conclusion. Our Two-point fixation technique is refinement of already performed and tried fixation techniques to prevent redundancy of the colon conduit considering kinetics, anatomical alignment, and pathology.

Iso-peristaltic colonic loop interposition for the treatment of benign oesophageal stricture: a case report with review of literature

Corrosive oesophageal strictures are a common and debilitating condition in India. Patients generally have dysphagia, cachexia, drooling of saliva, aspiration pneumonitis, and lung abscess. Though endoscopic dilatations are done in cases of short segment strictures, surgical oesophageal by pass is the permanent solution for this condition. A 24 years female presented with complaints of dysphagia and cachexia, due to corrosive stricture. Patient had a history of poison ingestion 2 years back. Intra-operatively stricturous mucosa is excised and an iso peristaltic colonic loop by pass was carried out. Post operatively patient had a complication of anastomotic leak which was treated conservatively, excepting which patient is symptom free and gaining weight on a follow up period of 1 year. Ever since first described by Kelling and Vuillet in 1911 colonic interposition is mostly used around the globe for oesophageal bypass in both benign and malignant conditions. Stomach and jejunum are the other conduits that can be used. Iso peristaltic loop is mostly used to reduce the incidence of reflux. Right colon or transverse colon graft based on the mid colic artery or the left colic artery owing to the reliable blood supply and less diameter. This procedure has a high complication rate of around 27% most of which are due to the vascular comprise of the graft.

Complications of esophageal strictures dilatation in children. A tertiary-center experience.

Objectives:To report the results of endoscopic dilatation of esophageal strictures in children, its complications, and their management. The outcomes of esophageal dilatation differ according to the underlying etiology.Methods:The study included 46 patients who underwent esophageal dilatation between 2014-2019. All patients underwent a contrast study of the esophagus before endoscopic dilation to determine the location, number, and length of the narrowing. In addition, the type of dilators (balloon versus semi-rigid dilators), the number of dilatation sessions, the interval between them, and the duration of follow-up were also documented. The median age was 2.47 years, and 26 patients were females. Dysphagia was the main presenting symptom, and the leading cause of stricture was esophageal atresia.Results:The main treatment modality was endoscopic balloon dilatation (n=29, 63%). The esophageal diameter was significantly increased after dilation (9 [7-11] versus 12 [10-12.8]) mm; p<0.001). Topical mitomycin-C was used as adjuvant therapy in 3 patients (6.5%). Esophageal perforation was reported in 2 cases (4.3%). Patients needed a median of 3 dilatation sessions, 25-75th percentiles: 1-5, and the median duration between the first and last dilatation was 2.18 years 25-75th percentiles: 0.5-4.21.Conclusion:Esophageal dilatation is effective for the management of children with esophageal stricture; however, repeated dilatation is frequent, especially in patients with corrosive strictures. Complications are not common, and open surgery is not frequently required.

Spontaneous Perforation of a Malignified Corrosive Stricture of the Esophagus and Subsequent Perforation of a Giant Duodenal Stress ULCUS

Abstract Surgical interventions for corrosive stricture of the esophagus are extremely difficult and technically challenging. In this manuscript, we present a patient with esophagectomy due to perforation of a corrosive stricture of the esophagus that underwent malignant transformation and subsequent perforation of a giant duodenal stress ulcus, which occurred 12 days after the intervention. We performed a total esophagectomy, pharyngo- and gastrostomy, suture of the duodenal perforation but the postoperative period was challenging and despite our efforts, the patient died on the 50th postoperative day due to respiratory and renal failure.

Place and significance of reconstructive surgical interventions in patients with high corrosive strictures of the bile ducts

The most technically difficult for reconstructive interventions on the bile ducts with a high level of postoperative complications and recurrences are strictures of “-1”, “-2” and “-3” types according to E. Halperin (type E3 - E5 according to Bismuth-Strasberg). From 2012 to 2018 the A.V. Vishnevsky Institute of Surgery treated 96 patients with this pathology. The best treatment results were observed in patients with preserved confluence – 92% of successful interventions. An independent risk of stricture recurrence is previous external drainage of the bile ducts after injury, a high level of stricture (“-1”, “-2” and “-3” types according to E. Halperin). Surgical treatment of corrosive strictures is the method of choice when there is the ineffectiveness of endoscopic and percutaneous transhepatic biliary drainage, although it is associated with a high risk of postoperative complications.

A rare case report of oesophagocoloplasty with distal colo-jejunal anastomosis in the management of post corrosive strictures of the oesophagus

Ingestion of corrosive substances and chronic sequelae associated with it is the major public health problem in the developing countries. The most severe forms of injury can lead to mortality; however, the major concern with this type of injury in life-long morbidity. Colonic conduit for bypassing diseased oesophagus with distal anastomosis with stomach is well documented and practiced procedure. Authors have encountered a case of 21-year-old lady with corrosive injuries to oesophagus and stomach, later developed non dilatable oesophageal stricture with completely cicatrised and adherent stomach. Due to unavailability of stomach, authors have used colon as a conduit and colo-jejunal anastomosis bypassing the oesophagus, stomach and duodenum. Colo-jejunal anastomosis for chronic corrosive oesophageal stricture is not commonly practiced procedure which makes this case a rare one.

MODERN METHODS OF PREVENTION AND TREATMENT OF COMPLICATIONS OF CERVICAL ESOPHAGO-ORGAN ANASTOMOSIS AT ESOPHAGOPLASTY

The aim: To improve the results of operative treatment of esophageal strictures by decreasing the rate of failure and stricture of cervical esophago-organ anastomoses. Materials and methods: There were 45 patients with post-burn corrosive gullet strictures, 17 patients with postoperative corrosive strictures, 10 patients with peptic strictures secondary to reflux-esophagitis, 42 patients with esophageal cancer strictures. The patients were divided into two groups: the comparison group - 55 persons and the main group - 59 persons. Patients of comparison group underwent surgical treatment of esophageal strictures according to classic protocols and standards. In the main group of patients we applied proposed diagnostic algorithm with prediction of complication risk and the designed method of esophago-organ anastomosis formation. Results: The results of operative treatment in patients with esophageal strictures showed the development of early postoperative complications in 59 individuals (51.75 %). In the postoperative period six patients died: four - in the comparison group and two - in the main group. Failure of cervical esophago-organ anastomosis and esophageal strictures occurred in 7 patients (11.86 %) of main group and 20 patients (36.36 %) of the comparison group (p<0.05). Conclusions: Application of method predicting the risk of complications of cervical anastomosis, treatment program and instrumental method of formation anastomosis resulted in reduced incidence of failure and strictures of esophago-organ anastomosis from 36.36 % to 11.86 % (p<0.05); decreased time of hospitalization - from 28.2 ± 1.1 to 21.5 ± 0.5 bed-days (p<0.001), postoperative period - from 20.5 ± 1.1 to 16.1 ± 0.7 bed-days (p<0.01); decreased postoperative mortality - from 7.27 % to 3.39 %.

Corrosive Poisoning Gastric Outlet Obstruction Treated by Early Definitive Surgery

Corrosive injury is common amongst young adults attempting suicide. Apart from oesophageal burns, many have predominant gastric injuries. Resulting gastric strictures need surgery in majority. Common practice is to do feeding jejunostomy followed by definitive surgery after a few months. But it is challenging in poor patients to maintain tube feeding. In view of this, we looked into alternative safe early definitive approach. This study was done in the Department of Surgical Gastroenterology in Medical College Kolkata. Over the last 8 years (January 2009 to April 2017), consecutive 74 patients with corrosive gastric strictures were included. Extent of gastric cicatrisation was assessed by endoscopy and barium study. Nutrition was maintained by oral, naso-jejunal or feeding jejunostomy. Early definitive surgery was preferred. Patients’ follow-up was evaluated. Patients presented with vomiting, weight loss and dysphagia. Out of 74 patients, 30 had associated oesophageal strictures which were amenable to dilatation. Pre-pyloric short strictures were found in 52 (70.27%) patients. Surgical procedures included stricturoplasty for short strictures (70%) and gastrojejunostomy for more severe gastric cicatrisation. Seventy-five per cent of the patients had definitive surgery within 3 months of injury. Complications included mortality in 3 (4.05%) patients and wound dehiscence, pneumonitis and ileus. All patients gained weight within 6 to 8 weeks and doing well during follow-up. Management of corrosive gastric injury depends on the extent of gastric involvement, associated oesophageal strictures and general condition of the patient. In majority, early definitive surgery like stricturoplasty, avoiding gastric resection or bypass provides very satisfactory and physiological outcomes.

Clinical profile of patients presenting with dysphagia - an experience from a tertiary care center in North India.

Background and AimDysphagia can lead to substantial morbidity and mortality, especially in the elderly. It has both benign and malignant causes. Despite having a varied etiology, there have been few studies in India. Therefore, a study was undertaken to evaluate the clinical profile and various etiologies of dysphagia.MethodsA prospective study was conducted on 220 patients with a complaint of dysphagia. Detailed history and examination, endoscopy and biopsies, and barium swallow were performed. Computed tomography and magnetic resonance imaging were performed wherever required. Patients who had an oropharyngeal or neurological cause of dysphagia were excluded.ResultsThe mean age of patients was 57.2 years, with the male: female ratio being 1.7:1. Of the patients, 35% (78 patients) had malignant etiology, with a mean age of 65.2 years, and 65% (142 patients) had a benign etiology, with a mean age of 51 years. Among the patients with malignancy, 56 had squamous cell carcinoma of esophagus (71.7%), 20 had adenocarcinoma of esophagus (25.7%), and 2 had gastric cardia adenocarcinoma (2.6%). Malignancy was most commonly located in distal esophagus (48 patients), and among the cases, 18 had involvement of the gastroesophageal junction. The most common benign cause was esophagitis secondary to reflux in 25.5% (56 patients), followed by esophageal ulcer in 5.9%, achalasia in 5%, corrosive stricture in 4.5%, and peptic stricture in 3.6%.ConclusionDysphagia has diverse etiology, and a majority can be diagnosed by endoscopy and barium swallow. Malignancy is an important cause of dysphagia in elderly. Esophageal squamous cell carcinoma remains the most common malignancy, but the incidence of gastroesophageal junctional adenocarcinoma is increasing.

Clinical outcomes following esophagectomy for benign esophageal diseases: a single center experience

Background: Surgery is the treatment option for wide range of benign esophageal diseases. But there are very few studies on Indian population, documenting the profile and clinical outcome of esophageal disease treated by surgical intervention. Hence author undertook a study to determine the clinical outcomes following esophagectomy for benign esophageal diseases.Methods: The current study was a prospective observational study, conducted in Velammal Medical College, Madurai. Data collection was done for 6 years from January 2012 to December 2017. Patients diagnosed with benign esophageal diseases were enrolled. The surgical procedures performed and outcomes were documented. Mean and standard deviation were used to summarize numeric variables, number and percentage were used to summarize categorical variables.Results: A total of 20 cases were included, with 11 men and 9 women. The mean age was 42.6±8.3 years. Dysphagia (90%) was the most common presentation, followed by heart burn (58%), regurgitation (40%) and chest pain (25%). Boerhaave syndrome (25%) was the most common diagnosis followed by foreign body perforation in 2(10%) patients. Corrosive stricture, peptic stricture, perforation following pneumatic dilatation and end stage achalasia were present in 2(10%) patients each. Jejunostomy and pyloroplasty were the procedure done in all cases. Stomach was the conduit used in 90% of patients. The conduit placement was done in the posterior mediastinum. The duration of the hospital stay ranged from 10 to 35 days. Mortality rate was 10%. Pulmonary morbidity (40%) was the most common post-operative complication, followed by wound infection (20%). Anastomotic stricture occurred among 30% of subjects.Conclusions: There is a high probability of occurrence complications following esophagectomy for benign disease. Clinicians must be aware of incidence of various complications, to be able to minimize and manage them effectively.

1733 Wonder Neutralization: Esophageal Stents in Caustic Injury

INTRODUCTION: Introduction Common causes for benign esophageal strictures (ES) are post -surgery, caustic ingestions and radiation therapy. Caustic strictures of the gastrointestinal tract can be a challenge to treat even after multiple endoscopic treatments due to its inherent relapsing nature. We report here our experience with self-expandable metallic stents (SEMS) in a patient with corrosive stricture of the esophagus. CASE DESCRIPTION/METHODS: Case A 25-year-old female with 2-year history of refractory ES due to caustic injury presented for endoscopic treatment. Patient had multiple endoscopic dilation attempts in past. Pediatric gastroscope showed esophageal stricture starting at 20 cm from the incisors however it could not traverse through the stricture. Under fluoroscopic guidance a 0.035 in x 260 cm guidewire was placed in the stomach. The proximal end of stricture was occluded by biliary 8.5 mm stone extraction balloon and contrast was injected through balloon catheter under fluoroscopy guidance showing 12 cm long significantly narrowed ES. A 18 mm × 103 mm fully covered esophageal metal stent (FCEMS) was placed under fluoroscopic guidance keeping the distal end of the stent above the gastroesophageal junction. Four days later, follow up EGD showed previously placed FCEMS was patent and widely open. The distal end of the stent was at 27cm and GEJ was at 35cm from entry point. Under fluoroscopic imaging and wire guidance another FCEMS (18 mm × 153 mm) was placed successfully to treat the left-over portion of the stricture below the previously placed stent. The second stent was deployed with in the first stent with its distal end at GEJ. Post stent placement, endoscopic and fluoroscopic imaging’s were satisfactory. At 2 weeks follow up, patient revealed significant improvement in her symptoms and ability to tolerate soft diet. DISCUSSION: Discussion ES secondary to caustic injury tend to require multiple dilation procedures, multiple hospitalizations with associated risks and cost, affecting patient’s quality of life. There is a need for novel therapeutic strategies that will provide a long-term solution. Our case highlights the growing interest and utility of multiple FCEMS in the treatment of severe and long ES. The deployment of multiple FCEMSs in our patient with long history of ES related dysphagia dramatically improved her symptoms and patency of esophagus.

Colon interposition in the treatment of corrosive esophageal strictures: 100 patients in seven years

Background: The purpose of this study is to represent the change in our concept of principles and techniques of esophagocoloplasty (midcolon esophagocoloplasty) with repetitive performance of the operation and approach of early surgical intervention (within 4-6 month of corrosive ingestion) in place of repetitive trials of dilatations and medical management, provides early better quality of life with lesser period of suffering and saving expenditure of treatment.Methods: This retrospective study comprises of consecutive 100 patients operated for colon interposition for corrosive stricture of esophagus done at two university linked government teaching hospitals during March 2011 to March 2018. Out of 100 patients, 77 female and 23 male (3:1), mean age 30.6 years (range from 21 to 47 years), mean hospital stay was 14.5 days (range 10 to 25 days) and mean operative duration was 4.5 hours (range 2.5 to 7 hours).Results: The 30 day in hospital mortality rate was 9%. There were 14 instances of leak at the esophagocolic anastomosis (14%), graft necrosis occurred in 01 patient, 08 patients (8%) developed stenosis at the esophagocolic anastomosis. More than 90% patients (n=77) had ‘Good’ result, 06 patients had ‘Fair’ and 02 had ‘Poor’ result.Conclusions: Midcolon graft is a solution for confusion in judgment of adequate length of graft and offer uniformity in procedure with effectively lesser operative time. Early (4-6 months after ingestion) operative intervention is advantageous to patients suffering from crippling dysphagia with repeated admission and expenditure from multiple endoscopic dilatations.

A Prospective Study Evaluating the Etiologic Spectrum in Patients with Dysphagia in Coastal Odisha Using Clinical Features and Endoscopy

Abstract Background: There is scarcity of data on the etiological spectrum of dysphagia from India. The study was conducted to determine the etiological spectrum of dysphagia in coastal Odisha. Materials and Methods: Consecutive patients presenting with dysphagia to the gastroenterology outpatient department in 2017 were studied. Patients were evaluated with meticulous history, clinical examination, esophagogastroduodenoscopy, and chest X-ray. Barium study and endoscopic biopsy were done when necessary. Results: Of 216 consecutive patients, 122 (56.48%) were male and 94 (43.52%) were female with a mean age of 42.3 ± 17.4 years. The common etiologies were benign stricture in 68 (31.48%) and esophageal carcinoma in 51 (23.62%). Other etiologies included achalasia cardia in 11 (5.09%), esophageal candidiasis in 10 (4.63%), pharyngeal cancer in 4 (1.85%), and esophageal web in 3 (1.39%). In 63 (29.17%) cases, no etiology was detected. Most of the benign strictures were due to corrosive injury in 48 (70.59%); other causes included peptic stricture (8, 11.76%), postsurgery (4, 5.88%), sclerotherapy-induced stricture (2, 2.94%), and pill-induced stricture (2, 2.94%); in 4 (5.88%) cases, the cause of stricture was not known. The most common cause of corrosive injury was acid injury in 38 (79.17%), followed by alkali injury in 4 (8.34%). In 6 (12.5%) cases, the nature of corrosive was not known. Most of the corrosive injuries were due to suicidal intake. Conclusion: In this study, the most common cause of dysphagia was benign corrosive stricture due to suicidal intake of corrosives. Esophageal carcinoma, achalasia cardia, and esophageal candidiasis were other significant etiologies. Uncommon causes of dysphagia included esophageal web, pharyngeal cancer, and reflux esophagitis.

Histopathological changes in the oesophageal mucosa in Egyptian children with corrosive strictures: A single-centre vast experience.

BACKGROUNDThe caustic ingestion continues to be a major problem worldwide especially in developing countries. The long-term complications include stricture and increased life time risk of oesophageal carcinoma. Patients suffered from corrosive induced oesophageal strictures have more than a 1000-fold risk of developing carcinoma of the oesophagus.AIMTo determine the possibility of oesophageal mucosal dysplasia after prolonged dilatation in post corrosive stricture.METHODSThis observational study was conducted at the Paediatric Endoscopy Unit in Cairo University Children’s Hospital. It included children of both sexes older than 2 years of age who had an established diagnosis of post-corrosive oesophageal stricture and repeated endoscopic dilatation sessions for more than 6 mo. All patients were biopsied at the stricture site after 6 mo of endoscopic dilatation. A histopathological examination of an oesophageal mucosal biopsy was performed for the detection of chronic oesophagitis, inflammatory cellular infiltration and dysplasia.RESULTSThe mean age of the enrolled children was 5.9 ± 2.6 years; 90% of the patients had ingested an alkaline corrosive substance (potash). The total number of endoscopic dilatation sessions were ranging from 16 to 100 with mean number of sessions was 37.2 ± 14.9. Histopathological examination of the specimens showed that 85% of patients had evidence of chronic oesophagitis (group A) in the form of basal cell hyperplasia, hyperkeratosis and subepithelial fibrosis. Thirteen percent of the patients had evidence of reactive atypia (group B) in the form of severe neutrophilic intraepithelial inflammatory cellular infiltration, and 2 patients (2%) had mild squamous dysplasia (group C); we rebiopsied these two patients 6 mo after the initial pathological assessment, guided by chromoendoscopy by Lugol's iodine.CONCLUSIONThe histopathology of oesophageal mucosal biopsies in post-corrosive patients demonstrates evidence of chronic oesophagitis, intraepithelial inflammatory cellular infiltration and dysplasia. Dysplasia is one of the complications of post-corrosive oesophageal stricture.

ESOPHAGOPLASTY WITH STOMACH OR COLON ESOPHAGOPLASTY IN CHILDREN? COMPARISON OF TREATMENT OUTCOMES

Purpose. A prospective study was carried out. It compared treatment outcomes in children who underwent esophagoplasty with stomach or colon esophagoplasty.Materials and methods. Clinical records of 172 patients who underwent esophagoplasty at N. F. Filatov Children’s Clinical Hospital No. 13 of Moscow from 2009 to 2015 were analyzed. The operated children were divided into two groups. 46 children from group 1 (basic group) aged 2 months to 13 years underwent esophagoplasty with stomach. 126 children aged 2 months to 18 years who had colon esophagoplasty were enrolled in group 2 (control group). In both groups, the majority was presented by children with atresia and corrosive strictures of esophagus. Clinical observation, esophagogastroduodenoscopy, contrast radiography, CT and MRI study, survey of patients were used to estimate direct and remote treatment outcomes.Results. The analyzed groups were comparable for the course of the early postoperative period. The early postoperative period had no complications in 54% of cases in group I and in 54.4% of cases in group II. Recurrent surgeries for complications were more frequent in group I (23.9%) as compared to group II until signifcant indices were reached (10.3%, p = 0.04). In the comparison groups, patients’ quality of life were signifcantly different by the rate of almost any complications in the remote period. They demonstrated better quality of life for children after colon esophagoplasty.Conclusion. Higher quality of life in children after colon esophagoplasty compared to children following esophagoplasty with stomach indicates that this is a surgery of choice in children.