Post-corrosive Esophageal Stricture Research Articles

503. TOTAL ESOPHAGECTOMY AND GASTRIC PULL UP FOR POST CORROSIVE ESOPHAGEAL STRICTURE: FEASIBLE IN MOST CASES WITH EXCELLENT OUTCOME

Abstract Post corrosive esophageal stricture represent a big national problem in Egypt because of bad culture of using (POTASH K2CO3) a highly corrosive substance for washing clothes with accidental (children) or sometimes suicidal (adult) swallow of this corrosive substance. Extensive esophageal stricture resulted is the late consequence of such swallow with complete or partial dysphagia leading to severe malnutrition and death of many patients. Dilation was successful in mild cases and many other cases required surgery. We present our new surgical strategy in managing 96 cases of post corrosive esophageal stricture including early feeding jejunostomy as well introduction of MI technique. From January 2016 to January 2022 ,96 cases of failed dilation post corrosive esophageal stricture were included in the study. Three- fields total esophagectomy and gastric pull up with cervical stapled esophago-gastric anastomosis was the operation used for all cases. Pyloroplasty and feeding jejunostomy were done for all cases We followed the cases for development of any complications (leak, bleeding, respiratory problems and stricture). Laparoscopy was used in 49 (51%) cases and was successfully completed in 42cases (86%). Right thoracotomy and left cervicotomy were used in all cases. Mean operative time was 368 minutes. Early complications were in the form of leak: cervical 12 cases (12.5%), from pyloroplasty 3 cases (3%). All cases managed conservatively. Only one pyloroplasty leak required exploration. Bleeding occurred in 5 cases (5%) and managed conservatively. Respiratory problems occurred in 37 cases (39%) requiring prolonged intubation in 3 cases (3%). Postoperative dysphagia was noted in 9 cases (9%) due to anastomotic stricture managed by dilation. No mortality recorded. Our short- and long-term results of total esophagectomy and gastric pull up for post corrosive esophageal stricture are excellent with low morbidity and no mortality.

Successful Esophageal Replacement Surgery in a 3-Year Old with Post-corrosive Esophageal Stricture

Accidental caustic ingestion in children, though entirely preventable, continues to be present in developing countries. Gastrointestinal injuries following caustic ingestion in children range from mild to fatal. Presentation of such children to the medical facility could be early or sometimes late with complications. Management is based on the type of injury and could range from medical conservative management to complex surgical procedures. Such complex surgeries are almost unavailable in developing countries. We present a 3-year old who presented to our facility with an esophageal stricture following accidental caustic ingestion four months prior to presentation. He had a failed stricture dilatation and needed to be managed surgically; he subsequently had a good outcome, which is rare in developing countries.
 Keywords: Post-corrosive esophageal stricture, Esophageal replacement surgery

Transnasal Esophageal Stricture Dilatation using Savary–Gilliard Dilator System—A Novel Approach

AbstractTransnasal esophagoscopy is office-based procedure, used by otolarynologists and gastroenterologists for evaluation of dysphagia, odynophagia, esophageal stricture dilatations, and other numerous indications. Through the scope (TTS) balloon dilatation using ultrathin gastroscope is routine practice in patients with esophageal stricture (ES). Here, we are highlighting a case of post corrosive esophageal stricture with inadequate mouth opening dilated using savary gilliard (SG) dilator system transnasally.

PS01.113: RISK FACTORS FOR ESOPHAGEAL STRICTURE IN GRADE 2B AND 3A CORROSIVE ESOPHAGEAL INJURIES

Abstract Background Ingestion of corrosive agents remains an important public health problem. Early endoscopic examination of post-corrosive esophageal injuries has an important role in management of the patient. Publications document the risk of developing esophageal stricture as a sequential complication of esophageal injury grades 2b and 3a. Although there are studies describing the risk factors of post-corrosive stricture, there is limited literature on these factors. The aim of this study was to evaluate the different factors with post-corrosive esophageal stricture and non-stricture groups in endoscopic grades 2b and 3a of corrosive esophageal injuries. Methods Data were retrospectively analyzed in the patients with esophageal injury grades 2b and 3a between January 2011 and December 2017. Results 196 corrosive ingestion patients were admitted with 32 patients (15.8%) in grade 2b and 12 patients (6.1%) in grade 3a and stricture was developed in 19 patients (61.3%) with grade 2b and in 10 patients (83.3%) with grade 3a. Substances of alkaline reaction were predominant in stricture patients (68.4% in 2b Stricture group, 60% in 3a Stricture group). The patients’ height of non-stricture group was greater than that of stricture groups (2b Stricture group, 1.58 ± 0.08 m, 2b Non-stricture group, 1.66 ± 0.07 m, P < 0.004; 3a Stricture group, 1.52 ± 0.09 m, 3a Non-stricture group, 1.71 ± 0.02 m, P < 0.001). Omeprazole was more commonly used in non-stricture than stricture group (26.3% in 2b Stricture group, 69.2% in 2b Non-stricture group, P = 0.017; 50% in 3a Stricture group, 100% in 3a Non-stricture group, 1.71 ± 0.02 m, P = 0.015). Conclusion In this study, the corrosive esophageal injuries grades 2b and 3a are important groups of patients who are at risk of developing post-corrosive esophageal stricture. Alkaline substances play the major role in stricture sequelae. The height of patients and the prescription of omeprazole may help to minimize the risks of post-corrosive esophageal stricture. Disclosure All authors have declared no conflicts of interest.

Risk Factors for Esophageal Stricture in Grade 2b and 3a Corrosive Esophageal Injuries

Background and PurposePublications document the risk of developing esophageal stricture as a sequential complication of esophageal injury grades 2b and 3a. Although there are studies describing the risk factors of post-corrosive stricture, there is limited literature on these factors. The aim of this study was to evaluate the different factors with post-corrosive esophageal stricture and non-stricture groups in endoscopic grades 2b and 3a of corrosive esophageal injuries. MethodsData were retrospectively analyzed in the patients with esophageal injury grades 2b and 3a between January 2011 and December 2017. ResultsOne hundred ninety-six corrosive ingestion patients were admitted with 32 patients (15.8%) in grade 2b and 12 patients (6.1%) in grade 3a and stricture was developed in 19 patients (61.3%) with grade 2b and in 10 patients (83.3%) with grade 3a. The patients’ height of the non-stricture group was greater than that of stricture groups (2b stricture group, 1.58±0.08 m; 2b non-stricture group, 1.66±0.07 m; p< 0.004; 3a stricture group, 1.52±0.09 m; 3a non-stricture group, 1.71±0.02 m; p< 0.001). Omeprazole was more commonly used in the non-stricture than stricture group (26.3% in the 2b stricture group, 69.2% in the 2b non-stricture group, p= 0.017; 50% in the 3a stricture group, 100% in the 3a non-stricture group, 1.71±0.02 m, p= 0.015). ConclusionsThe height of patients may help to predict the risks and the prescription of omeprazole may help to minimize the risks of 2b and 3a post-corrosive esophageal stricture.

Diagnostics and methods of endoscopic treatment of post-caustic esophageal strictures

The article deals with stricture subsequent to esophageal corrosive injury and describes endoscopic treatment results and diagnostic methods. Etiologic and pathogenetic aspects of the esophageal corrosive injury development depending on damaging substance were reported and steroid endotherapy results considering modern classification were given. Clinical peculiarities of the disease were singled out according to endoscopic treatment results. Individual approaches to endoscopic and drug therapy in patients with caustic esophageal injury were covered depending on damaging substance and exposure time as well as postoperative follow-up of these patients. The aim of the study was to evaluate the results of endoscopic treatment of post corrosive esophageal strictures using pneumatic balloon and hydro-balloon dilatation with subsequent glucocorticosteroid drug submucosal injection. Material and methods. High-technology video endoscope system FUJINON EPX 4450 with HDTV imaging and digital chromoendoscopy Flexible spectral Imaging Color Enhancement (FICE) were used. Endoscopic examination included a detailed assessment of the esophageal mucosa condition (the presence of erosions, ulcers), centric or eccentric narrowing of the esophagus, the diameter of stricture determination, the possibility, feasibility and the staged manner of endoscopic treatment. Result and discussion. All patients underwent pneumatic balloon and then hydro-balloon dilatation without the balloon removing, but only changing air and water supply. The synthetic hormone Flosteron (2 ml) was injected into the submucosal layers of the fracture sites after dilatation in order to inhibit and decrease fibroblasts formation, which reduced the risk of the esophagus mucous membrane severe scarring. Conclusions: Endoscopic combined balloon dilatation in post corrosive esophageal strictures based on developed indications and technical aspects of performance is an effective and sufficiently safe method of treatment.

Treatment Modalities for Post Corrosive Esophageal Strictures: 5 Years Experience

Background: Management of post-corrosive esophageal strictures represents a major challenge for clinicians. There are many options for treatment as dilatation alone or dilatation with injection of corticosteroids, stent placement, and surgery. The aims of the study: This is a retrospective study to assess the success rate of different treatment modalities for post-corrosive esophageal stricture including: endoscopic dilatation, stenting or surgery and to define any complications. Methods: Clinical and endoscopic data for patients with post-corrosive esophageal stricture admitted to the endoscopy unit between September 2012 and September 2017 were collected. Retrospective analysis of data was done to detect the types of treatment, success rate and any detectable complications. Results: A total of 50 patients with their ages ranged between 3 and 20 years were included in this study. Male patients represented 54% (27 patients) and females were 23 (46%). The cause of caustic material ingestion was mainly accidental (47 patients, 94%) and only 3 patients were suicidal (6%). Dilatation was successful in most cases either with or without injection of corticosteroids (39 patients, 78%). Stenting was a good option in cases of refractory or recurrent dilatations (11 patients; 22%) with excellent results. Surgery rarely needed (only in one patient) and only when dilatation and stenting failed. Conclusions: Endoscopic treatment of post-corrosive esophageal stricture has a good result and low rate of complications. The covered self-expandable metal stent (SEMS) is a good option in cases of refractory strictures, surgery rarely needed and after failure of previous modalities.

Gastric tube esophagoplasty for pediatric esophageal replacement

BackgroundEsophageal replacement in children is indicated in cases of esophageal atresia with or without fistula, in case of long gap esophageal atresia or failed primary repair. Intractable post corrosive esophageal stricture is considered also a major indication for replacement. MethodsThis is a cohort retrospective study of esophageal replacement cases by gastric tube carried out at the pediatric surgery department at Cairo University between 2011 and 2015. We reported 50 patients (30 boys and 20 girls); the ages ranged from 7months to 9years. Esophageal atresia cases were 27 while caustic esophageal stricture cases were 23. Isoperistaltic gastric tube technique was done in 45 patients while antiperistaltic (reversed) gastric tube technique was done in 5 cases. Retrosternal route was chosen in 38 patients while transhiatal route was chosen in 12 patients. ResultsLeakage and stricture were the most common complications. We had 5 cases of mortality, which were caused mainly by chest related complications. We had excellent to good results during long term follow up in terms of weight gain, swallowing pattern, quality of life, and overall satisfaction ConclusionGastric tube is a satisfactory surgical method for esophageal replacement in children. Level of EvidenceIII.

Posterior Cologastric Anastomosis: An Effective Antireflux Mechanism in Colonic Replacement of the Esophagus

The colon may be used to replace a portion of the esophagus in pediatric patients, but prevention of gastrocolic reflux is a concern. We report our experience with the retrosternal colon bypass, and the effect of combining the procedure with a posterior cologastric anastomosis on prevention of gastrocolic reflux. The study included 35 consecutive pediatric patients who underwent retrosternal colon bypass during the period of 2010 through 2014. In standard practice, the cologastric anastomosis is performed at the anterior gastric wall. Lately, we modified our technique by shifting the cologastric anastomosis to the back of the stomach away from the anterior adhesions around the gastrostomy. In follow-up, a gastrogram was performed to check for gastrocolic reflux. The indication for esophageal replacement was postcorrosive esophageal stricture in 19 patients and long gap esophageal atresia in 16 patients. Their mean ages were 51 and 16 months, respectively. No gastrocolic reflux was detected with the posterior cologastric anastomosis, whereas reflux was always present with the anterior cologastric anastomosis. We had two mortalities and one major morbidity (hematemesis and failure to thrive) that were related to regurgitation of gastric contents into the colonic conduit. The last patient was successfully managed by transferring the cologastric anastomosis from the front to the back of the stomach, with marked symptomatic and radiologic improvement. After colonic replacement of the esophagus, the gastrocolic reflux represents a functional problem that may lead to serious complications. Combining a posterior cologastric anastomosis with retrosternal colon bypass is an effective way to avoid this problem.

A prospective controlled study to assess the use of mitomycin C in improving the results of esophageal dilatation in post corrosive esophageal stricture in children

ObjectivesThe aim of this study is to investigate the efficacy of topical application of mitomycin C after dilation in pediatric patients having post corrosive esophageal stricture. MethodsThirty patients with post corrosive esophageal strictures were divided into two groups: 12 patients had repeated esophageal dilation without mitomycin C application, 18 patients had repeated esophageal dilation and topical application of mitomycin C. ResultsThere was a highly significant difference in the improvement of dysphagia grade at the end of follow up in the mitomycin C group (p=0.005). The number of repetition of dilatation ranged from 2 to 6 (median=3) in the 1st group, and 2 to 4 (median=2.5) in the mitomycin C group. There were no adverse effects from the topical application of the mitomycin C. ConclusionsTopical application of mitomycin C after oesophageal dilation can be beneficial in improving dysphagia in patients with post corrosive oesophageal stricture.

Transhiatal esophagectomy with gastric transposition for esophageal replacement in post-corrosive stricture in children

Despite potential advantages of gastric transposition there are some concerns about this surgical technique of esophageal substitution in children. In the current study the morbidity and functional outcome are surveyed in a series of patients undergoing gastric transposition due to extensive post-corrosive esophageal strictures. Retrospective analysis of children proposed for esophageal replacement from September 2003 through April 2007 after endoscopic dilations failure. Demographic and pathological features, intra and postoperative complications and clinical outcome were assessed. Continuous variables are expressed as median [range]. There were six children (age: 4.3 [2.5;14.4] years) with esophageal structures secondary to corrosive alkali ingestion; five had been submitted to dilation (n = 8 [7;27]) and one had undergone gastrostomy. Esophagectomy without thoracotomy plus gastric transposition were uneventfully performed in all cases. There was no mortality. On postoperative course there was one hypertensive pneumothorax and one pneumonia. With a follow-up of 50 [38;80] months, two children experienced mild dysphagia that was promptly solved by one or two sessions of dilations of esophagogastric anastomosis; both weight and height were between 5th and 75th centiles; none presented gastrointestinal or recurrent respiratory symptoms, anemia or substitute dilation. CONCLUSION. Transhiatal esophagectomy with gastric transposition in posterior mediastinum presented low morbidity and excellent functional outcome with no impairment of growth or respiratory function, at least on short/medium term.

Laparoscopically assisted transhiatal esophagectomy with esophagogastroplasty for post-corrosive esophageal stricture treatment in children

A tight post-corrosive esophageal stricture in a child poses significant surgical challenges. Many studies have described minimally invasive esophagectomy in adults, but very few reports have described this technique in children. Minimally invasive esophagectomy represents a new alternative to conventional open esophagectomy. This retrospective study evaluated the safety and efficacy of laparoscopically assisted transhiatal esophagectomy and gastric transposition for post-corrosive esophageal stricture treatment. Twenty-seven children with post-corrosive esophageal stricture were subjected to this technique. Their ages ranged from 3 to 13.5 years (mean 5.6 years). Fourteen were females and thirteen were males. None of the procedures needed to be converted to an open approach, and there were neither intra-operative complications nor increased blood loss. Left-sided pneumothorax occurred in one case only (3.7%). The mean operating time was 160 min (range 120-180). Three patients were admitted postoperatively to intensive care unit for a period of 48 h for assisted ventilation. Mean hospital stay was 4 days (range 3-7 days). Anastomotic leakage occurred in three patients (11.1%), while anastomotic stricture occurred in four patients (14.8%). About 93.5% of our cases have achieved excellent results. Post-operative nutritional status was satisfactory and accepted. Laparoscopically assisted transhiatal esophagectomy and gastric transposition for post-corrosive esophageal stricture treatment in children is safe, visible, effective, and an accepted operative technique. The cosmetic result is excellent.

A Technique to Improve Vascularity in Colon Replacement of the Esophagus

The aim of this study was to present a simple method to improve the results of colon replacement of the esophagus in children with post-corrosive esophageal stricture or long gap esophageal atresia. At the gastrostomy operation, the abdomen and colon are explored and the segment of colon to be used for replacement is chosen. The trunk of the middle colic artery supplying the transverse colon is ligated and divided proximally to the marginal artery or, if another segment of the colon is chosen, the corresponding vessel is ligated. Between November 1999 and October 2002, 11 children had their middle colic vessels ligated during a gastrostomy operation. They were six boys and five girls. Five neonates had long gap esophageal atresia with or without fistula. The other 6 had long segment esophageal stricture due to swallowing caustic potash. Their ages ranged from one day to 40 months. The hospital stay ranged from 10 to 14 days. The interval between vascular ligation and the replacement was one to three months, depending on the general condition of the patient. The follow-up period was between 21 and 56 months. After the definitive operation for colon replacement of the esophagus, the children resumed feeding through the gastrostomy on day five. They were fed by mouth from day eight and all had returned home by day 15. There was no wound infection, no fistula, or chest complications. One patient developed stricture at the colo-esophageal anastomosis two months after surgery. The esophageal anastomosis was excised six months after the colon interposition surgery and re-anastomosis was performed through the same neck incision, after which the patient was sent home seven days later. Ligation of the middle colic vessels during the gastrostomy operation increases the blood supply to the transverse colon through the left upper colic and marginal vessels. This adds an extra ten minutes to the gastrostomy operation. This technique has increased the success rate in colonic replacement and minimized morbidity in our unit. Although the principle is commonly used in plastic surgery in pedicled flap reconstruction and in pediatric surgery for high abdominal testis (Fowler Stephens procedure), to our knowledge, this has never been applied in intestinal surgery before.

Surgical management of long-term complications after dermatojejunoplasty of corrosive esophageal strictures

Authors present their experience in treatment of the long term complications after Lexer-Judin and Lexer-Judin-Papo operations. They discuss the advantages and disadvantages of these procedures. In the period from 1977 to 2003 in the Institute for digestive diseases 16 patients had to be operated because of the stenosis in the region of dermato-jejunal anastomosis or because of the bad esthetic results of this operations. They suggest that the extirpation of dermal tube, mobilisation of the jejunum and new pharyngo-jejunal anastomosis is the operation of choice.