Minimally invasive management of children with caustic ingestion: less pain for patients.
OBJECTIVE
Management of caustic ingestion in children is still controversial. In this study, we evaluate a minimally invasive management consisting of flexible endoscopy, balloon dilatation and intralesional steroid injection in children, with a history of caustic ingestion.


METHODS
Between April 2002 and January 2009, 350 (206 males and 144 females) children with a history of caustic ingestion were admitted. Enteral feeding was discontinued for 24 h. Parenteral feeding was started in patients with inadequate oral intake. No patient underwent an early esophagoscopy or gastrostomy. A contrast study of upper gastrointestinal tract was performed in all patients with persistent dysphagia within 3 weeks after injury. In case of an esophageal stricture, a dilatation program was initiated. For this purpose, a flexible esophagoscopy was performed. A guidewire was placed through the narrowed segment into the stomach and a balloon dilatator was inserted with the assistance of the guidewire. Balloon dilatations were performed every 1-3 weeks. In intractable strictures, triamcinolone acetonide (TAC) was injected into the narrowed segment via flexible endoscopy.


RESULTS
Seventeen patients (8 males, 9 females, median 3 years old) required esophageal dilatation. All of the patients completed dilatation program with complete relief of symptoms. None of the patients required any stent application nor esophageal replacement or gastrostomy. Ten patients underwent intralesional TAC injection. No patient had an esophageal perforation or any other complication related to dilatation. In all patients, the symptoms have been alleviated completely and no further dilatation was necessary after a median of five dilatation sessions (1-19 dilatations).


CONCLUSIONS
Minimally invasive management of caustic ingestion consisting of flexible endoscopy, guidewire-assisted esophageal balloon dilatation and intralesional TAC injection without any gastrostomy or esophageal stent/placement is effective and leads to relief of dysphagia in almost all patients. This method of dilatation is also safe and iatrogenic esophageal perforation is very unlikely.
Bicakci
Unal
U
Ondokuz Mayis University, Samsun, Turkey.
Tander
Burak
B
Deveci
Gulay
G
Rizalar
Riza
R
Ariturk
Ender
E
Bernay
Ferit
F
D000293:Adolescent; D002057:Burns, Chemical / Q000628:therapy*; D002404:Catheterization; D002424:Caustics / Q000506:poisoning*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004940:Esophageal Stenosis / Q000139:chemically induced* / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D015552:Injections, Intralesional; D008297:Male; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage
D002424:Caustics; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide