Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2019; 25(7): 870-879
Published online Feb 21, 2019. doi: 10.3748/wjg.v25.i7.870
Histopathological changes in the oesophageal mucosa in Egyptian children with corrosive strictures: A single-centre vast experience
Ayman Eskander, Carolyne Ghobrial, Nabil A Mohsen, Bahaa Mounir, Dalia Abd EL-Kareem, Sara Tarek, Mortada HF El-Shabrawi
Ayman Eskander, Carolyne Ghobrial, Nabil A Mohsen, Sara Tarek, Mortada HF El-Shabrawi, Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
Bahaa Mounir, Dalia Abd EL-Kareem, Department of Pathology, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
Author contributions: Eskander A designed the study; Ghobrial C, Mohsen NA, Mounir B, Abd EL-Kareem D and Tarek S participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; El-Shabrawi MH wrote and revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by ethical committee in our Departments of Pediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt. The scanned copy of ethical committee approval of the research protocol was attached in submitted files to the journal.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mortada HF El-Shabrawi, MD, Professor, Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, 1 Gamaa Street, Giza, Cairo 11562, Egypt. melshabrawi@kasralainy.edu.eg
Telephone: +201-2-28779388 Fax: +20-2-37619012
Received: November 14, 2018
Peer-review started: November 14, 2018
First decision: January 6, 2019
Revised: January 17, 2019
Accepted: January 26, 2019
Article in press: January 26, 2019
Published online: February 21, 2019
Abstract
BACKGROUND

The 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.

AIM

To determine the possibility of oesophageal mucosal dysplasia after prolonged dilatation in post corrosive stricture.

METHODS

This 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.

RESULTS

The 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.

CONCLUSION

The 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.

Keywords: Children, Endoscopic dilatation, Dysplasia, Oesophageal strictures, Post-corrosive

Core tip: Caustic ingestion continues to be a significant problem worldwide especially in developing countries. It has been reported that the accidental corrosive substance ingestion is seen mostly among children younger than 5 years of age. Corrosive ingestion in children may cause clinical manifestations varying from no injury to fatal outcome, including the risk for squamous cell carcinoma of the oesophagus. In this study, we analyzed our single-center experience, representing the largest series of paediatric patients with post-corrosive oesophageal stricture on repeated endoscopic dilatation sessions for more than 6-mo duration and histopathological examination of oesophageal mucosal biopsies were performed.