Corrosive oesophageal strictures in children: outcomes after timely or delayed dilatation.
OBJECTIVE
Among benign oesophageal lesions, caustic strictures are the most difficult to dilate. In low-income countries, children suffering caustic oesophageal injury are frequently referred to the hospitals late, sometimes weeks after ingestion. Therefore, dilatation may be performed late and in highly fibrotic strictures. Reports about endoscopic and clinical outcome of such delayed dilatations are scanty. The aim of this study was to evaluate the safety and efficacy of late caustic stricture dilatations in children, comparing it with the results of timely dilatations, both performed at the Hospital of the Italian Non-Governmental Organization "Emergency" at Goderich, Sierra Leone.


METHODS
From December 2005 to May 2007, 78 children (<15 years) complaining alkaline caustic ingestion were submitted to oesophageal dilatation, mainly (97%) using Savary dilators. Two groups were identified: children (group 1) with a late treatment (>6 weeks, 37+/-12 weeks), having arrived to the hospital late after ingestion, and children (group 2) dilated timely, i.e. at <6 weeks (4+/-1.4 weeks) after injury.


RESULTS
Strictures were severe in all patients. Twenty-five children were dilated late after injury (6.4 dilatations/patient) with a follow-up of 11+/-2.5 months. A successful clinical outcome was observed in 91.6%. Four perforations (2.6% procedure-related) and one death (4.0%) were observed. Strictures recurred once in 72% of patients, twice in 31.8%. Thirty-one children were dilated timely (4.5 dilatations/patient) with a follow-up of 10+/-2.1 months and a clinical success rate of 96.7%. Procedure-related perforation rate was 0.7% with one death (3.2%). Stricture recurred once in 30% and twice in 3.3%.


CONCLUSIONS
Delayed dilatation of caustic oesophageal strictures in children carries a higher risk of perforation and a higher recurrence rate.
Contini
S
S
Department of Surgical Sciences, School of Medicine & Dentistry, University of Parma, Italy. sandro.contini@unipr.it
Garatti
M
M
Swarray-Deen
A
A
Depetris
N
N
Cecchini
S
S
Scarpignato
C
C
D002057:Burns, Chemical / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004106:Dilatation / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D004939:Esophageal Perforation / Q000209:etiology; D004940:Esophageal Stenosis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D006801:Humans; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome