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Singh AK, Gunjan D, Dash NR, Poddar U, Gupta P, Jain AK, Lahoti D, Nayer J, Goenka M, Philip M, Chadda R, Singh RK, Appasani S, Zargar SA, Broor SL, Nijhawan S, Shukla S, Gupta V, Kate V, Makharia G, Kochhar R. Short-term and long-term management of caustic-induced gastrointestinal injury: An evidence-based practice guidelines. Indian J Gastroenterol 2025:10.1007/s12664-024-01692-1. [PMID: 39982600 DOI: 10.1007/s12664-024-01692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 09/15/2024] [Indexed: 02/22/2025]
Abstract
The Indian Society of Gastroenterology has developed an evidence-based practice guideline for the management of caustic ingestion-related gastrointestinal (GI) injuries. A modified Delphi process was used to arrive at this consensus containing 41 statements. These statements were generated after two rounds of electronic voting, one round of physical meeting, and extensive review of the available literature. The exact prevalence of caustic injury and ingestion in developing countries is not known, though it appears to be of significant magnitude to pose a public health problem. The extent and severity of this preventable injury to the GI tract determine the short and long-term outcomes. Esophagogastroduodenoscopy is the preferred initial approach for the evaluation of injury and contrast-enhanced computed tomography is reserved only for specific situations. Low-grade injuries (Zargar grade ≤ 2a) have shown better outcomes with early oral feeding and discharge from hospital. However, patients with high-grade injury (Zargar grade ≥ 2b) require hospitalization as they are at a higher risk for both short and long-term complications, including luminal narrowing. These strictures can be managed endoscopically or surgically depending on the anatomy and extent of stricture, expertise available and patients' preferences. Nutritional support all along is crucial for all these patients until nutritional autonomy is established.
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Affiliation(s)
- Anupam Kumar Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Deepak Gunjan
- Department of Gastroenterology and HNU, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Nihar Ranjan Dash
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ajay Kumar Jain
- Department of Gastroenterology, Choithram Hospital and Research Center, Indore, 452 014, India
| | - Deepak Lahoti
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, New Delhi, 110 017, India
| | - Jamshed Nayer
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Mahesh Goenka
- Institute of Gastrosciences and Liver Transplant, Apollo Multispeciality Hospitals, Kolkata, 700 054, India
| | | | - Rakesh Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Rajneesh Kumar Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Sreekanth Appasani
- Department of Gastroenterology and Hepatology, Krishna Institute of Medical Sciences, Secunderabad, 500 003, India
| | - Showkat Ali Zargar
- Department of Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Sohan Lal Broor
- Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospitals, New Delhi, 110 076, India
| | - Sandeep Nijhawan
- Department of Gastroenterology and Hepatology, Sawai Man Singh Medical College, Jaipur, 302 004, India
| | - Siddharth Shukla
- Department of Medicine and Gastroenterology, Base Hospital, Guwahati, 781 028, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Vikram Kate
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605 006, India
| | - Govind Makharia
- Department of Gastroenterology and HNU, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Rakesh Kochhar
- Department of Gastroenterology and Hepatology, Paras Hospital, Panchkula, 134 109, India.
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de Sousa Amaral M, Vasseur Maurer S, Reinberg O, Divjak N, de Buys Roessingh A. Outcomes of Colonic and Gastric Tube Transplants after Caustic Esophageal Burn in Children: A 33-Year Review. J Clin Med 2024; 13:4689. [PMID: 39200830 PMCID: PMC11355453 DOI: 10.3390/jcm13164689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 07/25/2024] [Accepted: 08/07/2024] [Indexed: 09/02/2024] Open
Abstract
Introduction: Accidental caustic burns of the esophagus in children represent a significant global health challenge, often necessitating esophageal reconstruction. The aim of this study is to compare the efficacy and morbidity related to esophagus replacement with colonic and gastric tube transplants in a pediatric population followed for caustic stenosis. Methods: This retrospective study was conducted at a tertiary pediatric surgery unit for children treated from January 1989 to December 2022. We compared colonic and gastric tube esophageal replacement. Short term (within 30 days) and mid-term outcomes and complications were reviewed. Statistical evaluation was considered using a Chi-square test for categorical data analysis. Results: A total of 124 children with caustic esophageal burns were included. Among them, 23 (18.5%) had a gastric tube transplant for esophagus replacement and 101 (81.5%) a colonic transplant. During surgical intervention, we found a significantly higher risk of complications when using a colonic transplant (34%, p < 0.001). There was no significant statistical difference in postoperative short term and mid-term complications between the two techniques. Twenty-six (26%) of the children required a reoperation, with a higher risk in the gastric tube transplant group (p < 0.001). Endoscopic dilatation after surgery was also performed on a higher number of children who had received a gastric tube transplant (p = 0.005). Overall, 97.6% recovered full normal oral feeding. Conclusions: We found that colonic and gastric tube replacement are both good options for pediatric esophageal replacement after a caustic injury and show effectiveness over time. Gastric tube transplants carried a slightly higher risk of reoperations and a higher number of dilatations post-surgery. However, our groups are not really comparable, due to the much higher number of colonic transplants. Both surgical options have to be considered during surgery, and the choice depends on the anatomy of the patient. Our future research will focus on assessing long term quality of life and the potential risk of neoplastic complications.
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Affiliation(s)
- Michaël de Sousa Amaral
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), 1011 Lausanne, Switzerland
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Li L, Xu N, Wang P, Liu L, Gong W, Bi Y, Ru N, Su S, Wang N, Xiang J, Han K, Chai N, Linghu E. A novel self-inflatable balloon for treating refractory benign esophageal strictures: a prospective, single-arm, multicenter study. Int J Surg 2024; 110:2055-2064. [PMID: 38668658 PMCID: PMC11020001 DOI: 10.1097/js9.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/09/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND AND AIM Current treatments for refractory benign esophageal strictures (BESs) often take several years and have poor effects. The authors propose a novel method of self-help inflatable balloon (SHIB) and evaluate its efficacy and safety. METHODS A prospective, multicenter study was conducted from January 2019 to March 2022. All enrolled patients were diagnosed with refractory BESs and received SHIB. The primary endpoint was the clinical success rate at 12 months after removing SHIB. The secondary endpoints were the number of days of placing SHIB, and changes from baseline in BMI and health-related quality of life at 1, 3, 6, and 12 months. RESULTS The clinical success rate was 51.2% (21/41) with the median days of placing SHIB being 104.0 days (range: 62.0-134.5 days), which was higher in the endoscopic group compared to the caustic and surgery groups (63.3 vs. 28.6% vs. 0, P=0.025). All patients (100%) showed significant improvement in dysphagia scores during placing SHIB. Although 20 patients (48.8%) experienced recurrent stricture, the median stricture length was decreased (P<0.001) and the median intervention-free interval was prolonged (P<0.001). In all patients, the mean BMI at and health-related quality of life at 1, 3, 6, and 12 months were significantly increased compared with baseline (P<0.05). On multivariate analysis, stricture etiology and wearing time were independent predictors of recurrent stricture. CONCLUSIONS The SHIB has high efficacy and safety in treating refractory BESs of different origins, especially for endoscopic resection. Stricture etiology and wearing time were independent predictors of recurrent stricture.
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Affiliation(s)
- Longsong Li
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing
| | - Ning Xu
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing
| | - Pengju Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing
| | - Li Liu
- The Second Hospital of Hebei Medical University, Shijiazhuang
| | - Wei Gong
- Shenzhen Hospital of Southern Medical University, Shenzhen, People’s Republic of China
| | - Yawei Bi
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing
| | - Nan Ru
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing
| | - Song Su
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing
| | - Nanjun Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing
| | - Jingyuan Xiang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing
| | - Ke Han
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing
| | - Ningli Chai
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing
| | - Enqiang Linghu
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing
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Vinay H G, G RR, Ramprashanth M P. Colonic transposition using mid colon for corrosive oesophageal strictures. Indian J Thorac Cardiovasc Surg 2024; 40:58-63. [PMID: 38125316 PMCID: PMC10728026 DOI: 10.1007/s12055-023-01531-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose To evaluate mid colon as a viable alternative for reconstruction in diffuse corrosive oesophageal stricture compared to other modes. Methods This is a prospective observational study of surgical management of corrosive oesophageal stricture using the colonic interposition graft. Eight patients were included for a period of 4 years from January 2017 to December 2020 and followed up for a mean period of 32 months (range of 24 to 46 months). The results in these eight patients are discussed. Results A total of 8 patients underwent retrosternal oesophagocoloplasty and gastrojejunostomy. There was no intraoperative or hospital death. Postoperative complications included one patient each having aspiration pneumonia and anastomotic leak. Conclusion A successful reconstruction can be done by securing the correct vascular pedicle and a technique of good anastomosis. From our experience, colonic transposition using mid colon as conduit can be considered as a viable alternative in patients with long segment oesophageal stricture.
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Affiliation(s)
- Vinay H G
- Department of General Surgery, Vydehi Institute of Medical Sciences & Research Centre, RGUHS, Bangalore, 560066 Karnataka India
| | - Ramesh Reddy G
- Department of General Surgery, Vydehi Institute of Medical Sciences & Research Centre, RGUHS, Bangalore, 560066 Karnataka India
| | - Ramprashanth M P
- Department of General Surgery, Vydehi Institute of Medical Sciences & Research Centre, RGUHS, Bangalore, 560066 Karnataka India
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Kalayarasan R, Durgesh S. Changing trends in the minimally invasive surgery for corrosive esophagogastric stricture. World J Gastrointest Surg 2023; 15:799-811. [PMID: 37342842 PMCID: PMC10277936 DOI: 10.4240/wjgs.v15.i5.799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/06/2023] [Accepted: 04/07/2023] [Indexed: 05/26/2023] Open
Abstract
Esophagogastric stricture is the troublesome long-term complication of corrosive ingestion with a significant adverse impact on the quality of life. Surgery remains the mainstay of therapy in patients where endoscopic treatment is not feasible or fails to dilate the stricture. Conventional surgical management of esophageal stricture is open esophageal bypass using gastric or colon conduit. Colon is the commonly used esophageal substitute, particularly in those with high pharyngoesophageal strictures and in patients with accompanying gastric strictures. Traditionally colon bypass is performed using an open technique that requires a long midline incision from the xiphisternum to the suprapubic area, with adverse cosmetic outcomes and long-term complications like an incisional hernia. As most of the affected patients are in the second or third decade of life minimally invasive approach is an attractive proposition. However, minimally invasive surgery for corrosive esophagogastric stricture is slow to evolve due to the complex nature of the surgical procedure. With advancements in laparoscopic skills and instrumentation, the feasibility and safety of minimally invasive surgery in corrosive esophagogastric stricture have been documented. Initial series have mainly used a laparoscopic-assisted approach, whereas more recent studies have shown the safety of a total laparoscopic approach. The changing trend from laparoscopic assisted procedure to a totally minimally invasive technique for corrosive esophagogastric stricture should be carefully disseminated to preclude adverse long-term outcomes. Also, well-designed trials with long-term follow-ups are required to document the superiority of minimally invasive surgery for corrosive esophagogastric stricture. The present review focuses on the challenges and changing trends in the minimally invasive treatment of corrosive esophagogastric stricture.
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Affiliation(s)
| | - Satish Durgesh
- Surgical Gastroenterology, JIPMER, Puducherry 605006, India
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Baskaran V, Banerjee JK, Ghosh SR, Kumar SS, Dey SK, Kulkarni SV, Bharathi RS. Minimal access surgery of corrosive and thermal strictures of the foregut. J Minim Access Surg 2023; 19:1-19. [PMID: 36722526 PMCID: PMC10034818 DOI: 10.4103/jmas.jmas_140_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/22/2022] [Accepted: 08/28/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND AIM : Conventional surgery for caustic/thermal strictures (CS/TS) entails considerable trauma, which may be mitigated by minimal access surgery (MAS). Experience with its use in CS/TS is both heterogeneous and limited, hence, warrants a comprehensive review. METHODS : Medical literature/indexing databases were systematically searched for pertinent articles published in English, from 1990 to 2021, and analysed. RESULTS : Fifty relevant articles, pertaining to over 200 patients, were found. They showed that MAS is feasible in CS/TS management. It reduces the access damage in chest and abdomen whilst facilitating resection or bypass of the affected gut segment through different combination of operations, sequence of steps, conduits and routes. The procedures range from completely minimal access to hybrid ones, with reduced complications and faster recovery. Hybrid procedures prove as expeditious as open ones. CONCLUSIONS : MAS proves efficacious in restoring alimentary continuity in corrosive/thermal strictures of the foregut.
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Affiliation(s)
- Vasudevan Baskaran
- Department of Gastro-Intestinal Surgery, MIOT Hospital, Chennai, Tamil Nadu, India
| | - Jayant Kumar Banerjee
- Department of Gastro-Intestinal Surgery, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India
| | - Sita Ram Ghosh
- Department of Gastro-Intestinal Surgery, IQ City Medical College, Durgapur, West Bengal, India
| | - Sukumar Santosh Kumar
- Department of Gastro-Intestinal Surgery, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
| | - Santosh Kumar Dey
- Department of Pediatric Surgery, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
| | - Shrirang Vasant Kulkarni
- Department of Gastro-Intestinal Surgery, Army Hospital (Research and Referral), New Delhi, India
| | - Ramanathan Saranga Bharathi
- Department of Gastro-Intestinal Surgery, Command Hospital (Northern Command), Udhampur, Jammu and Kashmir, India
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Use of free jejunal flap as a salvage procedure in the management of high corrosive esophageal re-strictures: an institutional experience and review of literature. Langenbecks Arch Surg 2022; 407:2725-2732. [PMID: 35759020 DOI: 10.1007/s00423-022-02595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND High pharyngo-esophageal strictures following corrosive ingestion continue to pose a challenge to the surgeon, particularly in the developing world. With the advancements and increased experience with microsurgical techniques, free jejunal flaps offer a viable reconstruction option in patients with high corrosive strictures with previous failed reconstruction. We review our experience with free jejunal flap in three cases with high pharyngo-esophageal stricture following corrosive ingestion, with previous failed reconstruction. MATERIALS AND METHODS A total of three patients underwent salvage free jejunal flap after failed reconstruction for high pharyngo-esophageal strictures following corrosive acid ingestion. All the three patients developed anastomotic leak and subsequent stricture, two following a pharyngo-gastric anastomosis and one following a pharyngo-colic anastomosis. The strictured segment was bridged using a free jejunal graft with microvascular anastomosis to the lingual artery and common facial vein. All patients were followed-up at regular intervals. RESULTS AND CONCLUSIONS The strictured pharyngeal anastomotic segment was successfully reconstructed with free jejunal flap in all the three patients. Patients were able to take food orally and maintain nutrition without the need of jejunostomy feeding. On long-term follow-up (median: 5 years), there was no recurrence of dysphagia and all the patients had good health-related quality of life.
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8
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Nayar R, Varshney VK, Goel AD. Outcomes of Gastric Conduit in Corrosive Esophageal Stricture: a Systematic Review and Meta-analysis. J Gastrointest Surg 2022; 26:224-234. [PMID: 34506024 DOI: 10.1007/s11605-021-05124-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/13/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gastric conduit has emerged as the preferred treatment option for both esophageal bypass and replacement for corrosive stricture of the esophagus. There is a lack of consensus and a dearth of published literature regarding the short- and long-term complications of using a gastric conduit. This meta-analysis aims to evaluate the outcomes, morbidity, and complications associated with it. METHODS MEDLINE, Cochrane Library, and Google Scholar (January 1960 to May 2020) were systematically searched for all studies reporting short- and/or long-term outcomes and complications following the use of a gastric conduit for corrosive esophageal stricture. RESULTS Seven observational studies involving 489 patients (53.2% males, mean age ranging from 22.1 to 41 years) who had ingested a corrosive substance (acid in 74.8%, alkali in 20.7%, and unknown in the rest) were analyzed. Gastric pull-up was performed in 56.03% (274/489) of patients. Median blood loss in the procedure was 187.5 ml with a mean operative duration of 298.75 ± 55.73 min. The overall pooled prevalence rate of anastomotic leak was 14.4% [95% CI (6.2-24.0); p < 0.05, I2 = 67.38], and anastomotic stricture was 27.2% [95% CI (13-42.8); p < 0.001, I2 = 80.11]. Recurrent dysphagia according to pooled prevalence estimates occurred in 14.4% patients [95% CI (5.4-25.1); p < 0.05, I2 = 69.1] and 90-day mortality in 4.8% patients [95% CI (1.5-9.1%); I2 = 31.1, p = 0.202]. The dreaded complication of conduit necrosis had a pooled prevalence of 1.3% [95% CI (0.1-3.4%); I2 = 0, p = 0.734]. CONCLUSION The stomach can be safely used as the conduit of choice in corrosive strictures with an acceptable rate of complications, postoperative morbidity, and mortality.
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Affiliation(s)
- Raghav Nayar
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area, Phase-II, Jodhpur, 342005, Rajasthan, India
| | - Vaibhav Kumar Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area, Phase-II, Jodhpur, 342005, Rajasthan, India.
| | - Akhil Dhanesh Goel
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Sarma MS, Tripathi PR, Arora S. Corrosive upper gastrointestinal strictures in children: Difficulties and dilemmas. World J Clin Pediatr 2021; 10:124-136. [PMID: 34868889 PMCID: PMC8603639 DOI: 10.5409/wjcp.v10.i6.124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/30/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
Children constitute 80% of all corrosive ingestion cases. The majority of this burden is contributed by developing countries. Accidental ingestion is common in younger children (< 5 years) while suicidal ingestion is more common in adolescents. The severity of injury depends on nature of corrosive (alkali or acid), pH, amount of ingestion and site of exposure. There are multiple doubts and dilemmas which exist in management of both acute ingestion and chronic complications. Acute ingestion leads to skin, respiratory tract or upper gastrointestinal damage which may range from trivial to life threatening complications. Esophagogastroduodenoscopy is an important early investigation to decide for further course of management. The use of steroids for prevention of stricture is a debatable issue. Upper gastrointestinal stricture is a common long-term sequelae of severe corrosive injury which usually develops after three weeks of ingestion. The cornerstone of management of esophageal strictures is endoscopic bougie or balloon dilatations. In case of resistant strictures, newer adjunctive therapies like intralesional steroids, mitomycin and stents can be utilized along with endoscopic dilatation. Surgery is the final resort for strictures resistant to endoscopic dilatations and adjunctive therapies. There is no consensus on best esophageal replacement conduit. Pyloric strictures require balloon dilatation , failure of which requires surgery. Patients with post-corrosive strictures should be kept in long term follow-up due to significantly increased risk of carcinoma. Despite all the endoscopic and surgical options available, management of corrosive stricture in children is a daunting task due to high chances of recurrence, perforation and complications related to poor nutrition and surgery.
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Affiliation(s)
- Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Parijat Ram Tripathi
- Department of Pediatric Gastroenterology, Ankura Hospsital for Women and Children, Hyderabad 500072, Telangana, India
| | - Sachin Arora
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
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10
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Tustumi F, Seguro FCBDC, Szachnowicz S, Bianchi ET, Morrell ALG, da Silva MO, Duarte AF, de Sousa JHB, Laureano GG, da Rocha JRM, Sallum RAA, Cecconello I. Surgical management of esophageal stenosis due to ingestion of corrosive substances. J Surg Res 2021; 264:249-259. [PMID: 33839340 DOI: 10.1016/j.jss.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Corrosive ingestion is a significant challenge for healthcare systems. Limited data are available regarding the best treatments, and there remains a lack of consensus about the optimal surgical approach and its outcomes. This study aims to review the current literature and show a single institution's experience regarding the surgical treatment of esophageal stenosis due to corrosive substance ingestion. METHODS A retrospective review that accounted for demographics, psychiatric profiles, surgical procedures, and outcomes was performed. A systematic review of the literature was performed using PubMed. RESULTS In total, 27 surgical procedures for esophageal stenosis due to corrosive substance ingestion were performed from 2010 to 2019. Depression and drug abuse were diagnosed in 30% and 22% of the included patients, respectively. Esophagectomies and esophageal bypasses were performed in 13 and 14 patients, respectively. No 30-day mortality was recorded. CONCLUSION Surgical intervention either by esophagectomy or esophageal bypass results in durable relief from dysphagia. However, successful clinical outcomes depend on a high-quality multidisciplinary network of esophageal and thoracic surgeons, intensivists, psychologists, psychiatrists, and nutritional teams.
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Affiliation(s)
- Francisco Tustumi
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil.
| | | | - Sérgio Szachnowicz
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Edno Tales Bianchi
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Andre Luiz Gioia Morrell
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Matheus Oliveira da Silva
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - André Fonseca Duarte
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | | | - Gabriela Gomes Laureano
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Ivan Cecconello
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
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Debourdeau A, Barthet M, Benezech A, Vitton V, Gonzalez JM. Assessment of long-term results of repeated dilations and impact of a scheduled program of dilations for refractory esophageal strictures: a retrospective case-control study. Surg Endosc 2021; 36:1098-1105. [PMID: 33650008 DOI: 10.1007/s00464-021-08376-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 02/09/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION In patients with benign and refractory esophageal strictures (BES), repeating initial dilations in short intervals could be recommended, but little data are available to validate this strategy. Our aim was to evaluate long-term results of a scheduled program of repeated and sustained esophageal dilations in patients with refractory strictures. METHODS Patients with BES requiring five or more dilations were retrospectively included and divided in two groups for analysis: a SCHEDULED group (SDG) where patients were systematically rescheduled for the 5 first dilations; ON-DEMAND group (ODG) where patients were dilated only in case of recurrence of the dysphagia. Comparison between SDG and ODG was done with a 1:1 matching analysis and etiology of stricture. Clinical success was defined as the absence of dysphagia for more than a year. RESULTS 39 patients with refractory BES were included with post-operative stenosis in 51.2% and post-caustic injury 28.2%; 10 were in SDG and 29 in ODG. In overall analysis (39 patients), the follow-up was 64.4 ± 32 months, success rate was 79.5% and duration of treatment was 27.3 ± 20 months, and mean number of dilations was 11.7 per patient. The need for dilations decreased significantly after 18 months of treatment with an average of 0.56 dilations per semester. Self-expandable metallic stent insertion was associated with an increased rate of complications (5.9% vs 59.1% p = 0.001). In matched analysis (10 ODG vs 10 SDG patients), the duration of treatment was lower in SDG (18.8 vs 41.4 months, p = 0,032) with a higher probability of remission (survival analysis, Log-rank: p = 0,019) and the success rate did not differ between ODG and SDG patients (80% vs 90%; NS). CONCLUSION Overall, long-term esophageal dilations resulted in a 79.5% success rate and the need for further dilatations decreased significantly in both groups after 18-month follow-up. A scheduled dilation program was associated with a higher probability of final success and lower treatment duration.
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Affiliation(s)
- Antoine Debourdeau
- Endoscopy Unit, CHU Saint Eloi, Université de Montpellier, 80 avenue Gaston Fliche, 34090, Montpellier, France.
| | - Marc Barthet
- Digestive Endoscopy Unit, North Universitary Hospital, Marseille, France
| | | | - Véronique Vitton
- Gastroenterology Unit, North Universitary Hospital, AP-HM, Marseille, France
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12
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Anand U, Kumar R, Priyadarshi RN, Parasar K, John AG. An Unusual Postoperative Complication of Retrosternal Gastric Pull-Up for Corrosive Esophageal Stricture. Cureus 2020; 12:e12323. [PMID: 33520521 PMCID: PMC7837637 DOI: 10.7759/cureus.12323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 11/28/2022] Open
Abstract
Retrosternal gastric pull-up with side-to-side esophagogastric anastomosis is the surgery done for corrosive esophageal stricture unresponsive to endoscopic dilatation. This surgery is considered safe in terms of morbidity. Complications due to leak from distal esophageal staple line as a result of partially patent bypassed esophageal lumen have never been reported with this surgery. Herein, we report a case in which a leak from distal esophageal staple line resulted in intraabdominal fluid collection, a life-threatening complication. This complication necessitated a second surgery that involved exclusion of the native esophagus at the neck.
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Affiliation(s)
- Utpal Anand
- Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, IND
| | - Ramesh Kumar
- Gastroenterology, All India Institute of Medical Sciences, Patna, IND
| | | | - Kunal Parasar
- Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, IND
| | - Aaron G John
- Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, IND
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13
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Gurram RP, Kalayarasan R, Gnanasekaran S, Pottakkat B. Minimally Invasive Retrosternal Esophageal Bypass Using a Mid-Colon Esophagocoloplasty for Corrosive-Induced Esophageal Stricture. World J Surg 2020; 44:4153-4160. [PMID: 32754784 DOI: 10.1007/s00268-020-05719-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Colonic bypass for corrosive-induced esophageal stricture is traditionally performed using an open approach. The laparoscopic mid-colon retrosternal esophageal bypass has not been previously reported. The present study is aimed to report the feasibility of laparoscopic mid-colon esophagocoloplasty and to compare the short- and medium-term outcomes with the open approach. MATERIALS AND METHODS Patients who underwent surgery for corrosive esophageal stricture between August 2016 and August 2019 were retrospectively analyzed. Laparoscopic procedure was preferred in patients with stricture starting at or below the level of cricopharynx and without prior laparotomy. The perioperative and medium-term outcomes of patients who underwent open and laparoscopic mid-colon bypass were compared. RESULTS Of the 15 patients, seven patients underwent laparoscopic mid-colon bypass, and eight patients underwent the open procedure. The duration of surgery was less in the laparoscopic group, but the difference was not significant (440 vs. 510 min, P = 0.93). Intraoperative blood loss (median) and postoperative analgesic requirement (median days) were significantly lower in laparoscopic group (200 mL vs. 350 mL, P = 0.03 & 3 vs. 5, P = 0.02). There was no significant difference in the postoperative complications, ICU and hospital stay between the two groups. At a median (range) follow-up of 14 (7-42) months, all patients in the minimally invasive colon bypass group were euphagic to regular Indian diet. Two patients in the open group developed anastomotic stricture requiring endoscopic dilatation. CONCLUSION Minimally invasive mid-colon esophageal bypass is a feasible procedure for selected patients with corrosive esophageal stricture with favorable short-term and comparable medium-term outcomes.
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Affiliation(s)
- Ram Prakash Gurram
- Department of Surgical Gastroenterology, JIPMER, Room no 5442, Fourth floor, Superspeciality block, Puducherry, 605006, India
| | - Raja Kalayarasan
- Department of Surgical Gastroenterology, JIPMER, Room no 5442, Fourth floor, Superspeciality block, Puducherry, 605006, India.
| | - Senthil Gnanasekaran
- Department of Surgical Gastroenterology, JIPMER, Room no 5442, Fourth floor, Superspeciality block, Puducherry, 605006, India
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, JIPMER, Room no 5442, Fourth floor, Superspeciality block, Puducherry, 605006, India
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Joshi P, Yadav R, Dangi A, Kumar P, Kumar S, Gupta V, Gupta V, Chandra A. Corrosive Esophageal Strictures: From Dilatation to Replacement: A Retrospective Cohort Study. Dysphagia 2020; 35:558-567. [PMID: 31485830 DOI: 10.1007/s00455-019-10058-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/21/2019] [Indexed: 01/21/2023]
Abstract
Endoscopic dilatation is the recommended primary therapy for chronic corrosive esophageal strictures (ES), and surgery is reserved for failed dilatation. Through this study, we intend to analyze the efficacy and long-term outcomes of both endoscopic and surgical interventions in corrosive ES. A retrospective cohort analysis of patients with chronic corrosive ES, managed with endoscopic or surgical procedures at a tertiary teaching institute in North India from December 2009 to December 2016, was performed from a prospectively maintained database. The primary outcome measure was the absence of dysphagia following dilatation or surgery. During the study period, 64 patients with ES underwent surgical or endoscopic treatment. Associated gastric strictures and pharyngeal strictures were present in 39 (60%) and 22 patients (28.9%), respectively. The mean age was 28.8 years and mean BMI was 14.2 kg/m2. Acid was the most common corrosive substance. Endoscopic dilatation using Savary-Gilliard (SG) dilators was successful in achieving persistent symptom relief in 46 patients (71.8%) after a total of 358 sessions (mean number of dilatations were 5.2 ± 1.2) of dilatations over 2 years. The dilatation therapy failed in 18 patients (28.1%) including technical failures (15.6%), perforations (3.1%), refractory stricture (1.5%) and recurrent strictures (7.8%). Increasing stricture length (more than 6 cm) was associated with poor outcome of endoscopic dilatation (p < 0.001). Only eleven patients (17%) required esophageal replacement (resection: 0, bypass: 11) for failed dilatations including seven gastric pull-ups and four pharyngo-coloplasty. The stricture rate after surgery was 36.3% (4/11). The median follows up was 32 months. Endoscopic dilatation of corrosive ES is safe and effective therapy and should be the first-line therapy for these patients and surgery should be considered only in patients who have unsuccessful outcome following dilatation therapy.
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Affiliation(s)
- Pradeep Joshi
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Rakesh Yadav
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Amit Dangi
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Pavan Kumar
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Saket Kumar
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Vivek Gupta
- Department of Human Organ Transplant, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Vishal Gupta
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Abhijit Chandra
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
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Nayar R, Varshney V, Suman S, Soni S, Kumar N. Thoracolaparoscopic-Assisted Esophagectomy for Corrosive-Induced Esophageal Stricture. Cureus 2020; 12:e7909. [PMID: 32494524 PMCID: PMC7263410 DOI: 10.7759/cureus.7909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Corrosive-induced stricture of the digestive tract is a dreaded complication following corrosive ingestion. When surgical reconstruction is needed, esophagectomy helps to avoid the long-term complications related to leaving behind the scarred native esophagus. We tried to ascertain the feasibility and safety of a thoracolaparoscopic-assisted esophagectomy in such a setting. A 32-year-old male presented with corrosive-induced esophageal stricture that lead to progressive dysphagia not amenable for endoscopic dilatation. Thoracoscopic approach was used for mobilization of the scarred esophagus under vision. Laparoscopic approach was used in mobilizing the stomach and creating a conduit. Esophagogastric anastomosis was performed in the neck. The patient had an uneventful recovery postoperatively and was discharged after six days on a semisolid diet. Thoracolaparoscopic-assisted esophagectomy can be safely performed for corrosive strictures of the esophagus. Besides improving the ease of performing the procedure, it also helps mitigate the morbidity associated with conventional open surgery in such cases.
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Affiliation(s)
- Raghav Nayar
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Vaibhav Varshney
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Sunita Suman
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Subhash Soni
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Naveen Kumar
- Medical Gastroenterology, Mathura Das Mathur Hospital, Jodhpur, IND
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16
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Srivatsav A, Ghanayem R, Dahdal S, Khalaf N. Treatment of Esophageal Stricture After Lye Ingestion. ACG Case Rep J 2020; 7:e00348. [PMID: 32548185 PMCID: PMC7224708 DOI: 10.14309/crj.0000000000000348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/13/2020] [Indexed: 09/05/2023] Open
Abstract
Caustic ingestions represent a well-known public health concern. Ingestion of highly alkali agents (lye ingestion) from the consumption of cleaning products is common, with an estimated 200,000 cases reported annually in the United States. Long-term complications of lye ingestion include esophageal strictures, gastric stenosis, and cancer. We describe a 53-year-old woman who suffered from lye ingestion as a child complicated by refractory esophageal strictures. Twenty years after esophagectomy and colon interposition, she developed debilitating dysphagia with daily regurgitation. The case highlights the long-term gastrointestinal consequences of lye ingestion and the evolution of endoscopic and surgical treatments of known complications.
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Affiliation(s)
- Ashwin Srivatsav
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - Rami Ghanayem
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - Sami Dahdal
- Department of Internal Medicine, St. John's Riverside Hospital, Yonkers, NY
| | - Natalia Khalaf
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX
- Section of Gastroenterology and Hepatology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
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17
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An interventional radiology technique to treat pharyngeal or esophageal perforation associated with mediastinal abscess in children. J Pediatr Surg 2020; 55:437-440. [PMID: 31376916 DOI: 10.1016/j.jpedsurg.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/23/2019] [Accepted: 07/11/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE Pharyngeal or esophageal perforation with mediastinal abscess is notably dangerous in children and can be very difficult to treat. We aimed to determine the safety and efficacy of the transnasal placement of a mediastinal drainage catheter and a nasojejunal feeding tube, with or without gastric decompression, in the treatment of the above perforations in children. METHODS We placed transnasal mediastinal drainage catheters and nasojejunal feeding tubes in 14 pediatric patients. Patients with esophageal perforation also underwent the placement of a gastric decompression tube. Four of these patients additionally received chest drainage tubes. RESULTS The fistula healed after a median of 66 days (range, 5-404 days). Corrosive esophagitis occurred in two patients with pharyngeal perforations. One of these patients underwent surgical treatment 2 months after fistula healing, and the other underwent repeated balloon dilatation procedures for cicatricial restenosis. Four months after the fistula had healed, the patients with esophageal perforations were all free from recurrence. CONCLUSION The use of interventional radiology to place a transnasal mediastinal drainage catheter, a nasojejunal feeding tube, and a gastric decompression tube is a safe, easy, inexpensive, and efficacious way to treat pharyngeal or esophageal perforation complicated by mediastinal abscess in children. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level IV.
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18
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Outcomes of Endoscopic Dilation in Patients with Esophageal Anastomotic Strictures: Comparison Between Different Etiologies. Dysphagia 2019; 35:73-83. [PMID: 30929058 DOI: 10.1007/s00455-019-10004-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 03/23/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS This retrospective study was aimed at assessing the efficacy of endoscopic dilation for esophageal anastomotic strictures, and to compare response between caustic anastomotic strictures (CAS) and non-caustic anastomotic strictures (NCAS). MATERIALS AND METHODS Patients with anastomotic strictures (enrolled during January 1996-December 2015) were analyzed. Short- and long-term outcomes of dilation, in terms of clinical success, refractory, and recurrent strictures were compared between NCAS and CAS. Patients with refractory and recurrent strictures were managed with adjunctive therapy including intralesional steroids. Factors predicting refractoriness at start of dilation and reasons for more than ten lifetime dilations were also evaluated. RESULTS Of the 142 patients, 124 (mean age-44.02; males-74) underwent dilation. Clinical success was achieved in 113 (91.3%) patients requiring a median [Interquartile range (IQR)] of 4 (2-10) sessions. The number of dilations to achieve clinical success, refractory strictures, and recurrent strictures, and the use of adjunctive therapy were significantly higher for CAS than for NCAS. Intralesional steroid use decreased periodic dilation index (PDI) significantly in CAS. Caustic etiology and starting dilation diameter of < 10 mm were found to be predictors of refractoriness, with the former alone being an independent predictor of more than ten lifetime dilations. No patient had free perforation; however, five required revision surgery. CONCLUSION Patients with CAS fared worse than those with NCAS in terms of number of dilations, refractoriness, recurrence of strictures, and need of adjunctive therapy. Endoscopic dilation can successfully ameliorate dysphagia due to anastomotic strictures in a majority of patients.
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19
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Ferreira Junior EG, Costa PA, Freire Golveia Silveira LM, Pertile Salvioni NC, Loureiro BM, Lodi Peres SL, Pereira TJ. Transhiatal esophagectomy with gastric pull-up, pyloric exclusion and Roux-en-Y gastroenterostomy for the management of esophageal caustic injury. Int J Surg Case Rep 2019; 56:66-69. [PMID: 30831510 PMCID: PMC6403175 DOI: 10.1016/j.ijscr.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/30/2019] [Accepted: 02/06/2019] [Indexed: 11/18/2022] Open
Abstract
The authors present a surgical option for the management of esophageal caustic injury. The surgery consists of a transhiatal esophagectomy with gastric pull-up, pyloric exclusion and Roux-en-Y gastroenterostomy. The technique can be indicated when esophagectomy is necessary and there is pyloric stenosis associated. Introduction Ingestion of caustic materials can lead to digestive tube perforation involving the mouth, pharynx, esophagus and stomach (Vezakis et al., 2016 [1]). In this case report, the authors opted for gastric pull-up in a case of esophageal and pyloric stenosis secondary to caustic ingestion, and a Roux-en-Y gastroenterostomy in the lower portion of the gastric pull-up. Presentation of case A 37 years-old male presented complaints of dysphagia, which had started 28 days before admission after the ingestion of a caustic liquid. An esophagogastroduodenoscopy was performed, and showed a complete occlusion of the esophagus, without the possibility of performing an esophagus dilatation or placing a nasoenteric tube. The option was made for a transhiatal esophagectomy with gastric pull-up, pyloric exclusion and Roux-en-Y gastroenterostomy. The patient was later admitted with a stenosis of the esophageal anastomosis, which was resolved after performing endoscopic dilatation. Discussion The medical team opted to use the stomach for the reconstruction of the gastrointestinal transit due to less morbidity during manipulation of that organ, as well as safer anastomosis, when compared to the colon. In this case report, the esophagus and pylorus were generally compromised, however, with no apparent damage whatsoever in the stomach. Therefore, we opted to resect the esophagus and used the stomach to perform a gastric pull-up with the exclusion of the pylorus and reconstruction with a Roux-en-Y gastroenterostomy. Conclusion The proposed surgery is an option when dealing with similar cases, where endoscopic dilatation is not an option, and there is an associated pyloric stenosis.
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Affiliation(s)
| | - Philippos Apolinario Costa
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro CEP: 56304-917, Petrolina, PE, Brazil.
| | | | | | - Bruna Menon Loureiro
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro CEP: 56304-917, Petrolina, PE, Brazil.
| | - Sandra Lúcia Lodi Peres
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro CEP: 56304-917, Petrolina, PE, Brazil.
| | - Thiago Jardim Pereira
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro CEP: 56304-917, Petrolina, PE, Brazil.
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20
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Sami SS, Haboubi HN, Ang Y, Boger P, Bhandari P, de Caestecker J, Griffiths H, Haidry R, Laasch HU, Patel P, Paterson S, Ragunath K, Watson P, Siersema PD, Attwood SE. UK guidelines on oesophageal dilatation in clinical practice. Gut 2018; 67:1000-1023. [PMID: 29478034 PMCID: PMC5969363 DOI: 10.1136/gutjnl-2017-315414] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/03/2018] [Accepted: 01/14/2018] [Indexed: 01/10/2023]
Abstract
These are updated guidelines which supersede the original version published in 2004. This work has been endorsed by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG) under the auspices of the oesophageal section of the BSG. The original guidelines have undergone extensive revision by the 16 members of the Guideline Development Group with representation from individuals across all relevant disciplines, including the Heartburn Cancer UK charity, a nursing representative and a patient representative. The methodological rigour and transparency of the guideline development processes were appraised using the revised Appraisal of Guidelines for Research and Evaluation (AGREE II) tool.Dilatation of the oesophagus is a relatively high-risk intervention, and is required by an increasing range of disease states. Moreover, there is scarcity of evidence in the literature to guide clinicians on how to safely perform this procedure. These guidelines deal specifically with the dilatation procedure using balloon or bougie devices as a primary treatment strategy for non-malignant narrowing of the oesophagus. The use of stents is outside the remit of this paper; however, for cases of dilatation failure, alternative techniques-including stents-will be listed. The guideline is divided into the following subheadings: (1) patient preparation; (2) the dilatation procedure; (3) aftercare and (4) disease-specific considerations. A systematic literature search was performed. The Grading of Recommendations Assessment, Develop-ment and Evaluation (GRADE) tool was used to evaluate the quality of evidence and decide on the strength of recommendations made.
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Affiliation(s)
- Sarmed S Sami
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hasan N Haboubi
- Cancer Biomarker Group, Swansea Medical School, Swansea University, Swansea, UK
| | - Yeng Ang
- Department of GI Sciences, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Philip Boger
- Department of Gastroenterology, Southampton University Hospital, Southampton, UK
| | - Pradeep Bhandari
- Department of Gastroenterology, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - John de Caestecker
- Digestive Diseases Centre, University Hospitals of Leicester, Leicester, UK
| | - Helen Griffiths
- Department of Gastroenterology, Wye Valley NHS Trust, Wye Valley, UK
| | - Rehan Haidry
- Department of Gastroenterology, University College Hospital, London, UK
| | - Hans-Ulrich Laasch
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Praful Patel
- Department of Gastroenterology, Southampton University Hospital, Southampton, UK
| | - Stuart Paterson
- Department of Gastroenterology, NHS Forth Valley, Stirling, UK
| | - Krish Ragunath
- NIHR Nottingham Digestive Diseases Biomedical Research Centre, Queens Medical Centre, Belfast, UK
| | - Peter Watson
- Faculty of Medicine Health and Life Sciences, Queen's University Belfast, Belfast, UK
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Awad K, Jaffray B. Oesophageal replacement with stomach: A personal series and review of published experience. J Paediatr Child Health 2017; 53:1159-1166. [PMID: 28799279 DOI: 10.1111/jpc.13653] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/22/2017] [Accepted: 05/28/2017] [Indexed: 12/22/2022]
Abstract
AIM To describe the outcomes of oesophageal replacement using stomach in children. METHODS All children undergoing oesophageal replacement in a regional centre were prospectively recorded in a customised database and subjected to continual follow up. Complications within 30 days were classified as early, and all other complications were classified as late. Outcomes were related to a comprehensive analysis of published experience where studies were classified as having long-term follow up if the median duration exceeded 5 years. RESULTS Ten children underwent oesophageal replacement using the stomach between 1998 and 2016. Indications were oesophageal atresia (6), caustic ingestion (2), foreign body ingestion (1) and oesophageal hamartoma (1). Two children died at 2 and 7 months after gastric transposition. All survivors are under review, with a median follow up of 8.5 years (range 3-14 years). Complications occurred in every case. Among survivors, three had early complications and eight had late complications. Early complications included anastomotic leak (2) and lung compression by stomach (1). Late complications were anaemia (8), anastomotic stricture (7), oesophagitis (5), dumping syndrome (2), perforation of a jejunostomy (1), para-gastric hiatal hernia (1), gastric outlet obstruction (1), Barrett's oesophagus (1), prolonged inability to swallow (1) and recurrent lower respiratory tract infections (1). Among 57 publications, only three achieved complete long-term follow up. The incidence of reported complications was higher when follow up was complete. CONCLUSIONS Oesophageal replacement by gastric transposition in children leads to serious chronic morbidity. Published experience masks this because of incomplete and short follow up.
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Affiliation(s)
- Karim Awad
- Department of Paediatric Surgery, The Great North Children's Hospital, Newcastle upon Tyne, United Kingdom.,Department of Paediatric Surgery, Ain Shams University Hospitals, Cairo, Egypt
| | - Bruce Jaffray
- Department of Paediatric Surgery, The Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
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22
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Abstract
Corrosive ingestion is a rare but potentially devastating event and, despite the availability of effective preventive public health strategies, injuries continue to occur. Most clinicians have limited personal experience and rely on guidelines; however, uncertainty persists about best clinical practice. Ingestions range from mild cases with no injury to severe cases with full thickness necrosis of the oesophagus and stomach. CT scan is superior to traditional endoscopy for stratification of patients to emergency resection or observation. Oesophageal stricture is a common consequence of ingestion and newer stents show some promise; however, the place of endoscopic stenting for corrosive strictures is yet to be defined. We summarise the evidence to provide a plan for managing these potentially life-threatening injuries and discuss the areas where further research is required to improve outcomes.
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Affiliation(s)
- Mircea Chirica
- Department of Digestive and Emergency Surgery, University Hospital of Grenoble, Grenoble Alpes University, Grenoble, France.
| | - Luigi Bonavina
- University of Milan Medical School, Division of General Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Michael D Kelly
- Acute Surgical Unit, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Emile Sarfati
- Department of Digestive and Endocrine Surgery, Saint-Louis Hospital AP-HP, Université Paris Diderot Sorbonne Paris Cité, Paris, France
| | - Pierre Cattan
- Department of Digestive and Endocrine Surgery, Saint-Louis Hospital AP-HP, Université Paris Diderot Sorbonne Paris Cité, Paris, France
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23
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De Lusong MAA, Timbol ABG, Tuazon DJS. Management of esophageal caustic injury. World J Gastrointest Pharmacol Ther 2017; 8:90-98. [PMID: 28533917 PMCID: PMC5421115 DOI: 10.4292/wjgpt.v8.i2.90] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 02/25/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
Ingestion of caustic substances and its long-term effect on the gastrointestinal system maintain its place as an important public health issue in spite of the multiple efforts to educate the public and contain its growing number. This is due to the ready availability of caustic agents and the loose regulatory control on its production. Substances with extremes of pH are very corrosive and can create severe injury in the upper gastrointestinal tract. The severity of injury depends on several aspects: Concentration of the substance, amount ingested, length of time of tissue contact, and pH of the agent. Solid materials easily adhere to the mouth and pharynx, causing greatest damage to these regions while liquids pass through the mouth and pharynx more quickly consequently producing its maximum damage in the esophagus and stomach. Esophagogastroduodenoscopy is therefore a highly recommended diagnostic tool in the evaluation of caustic injury. It is considered the cornerstone not only in the diagnosis but also in the prognostication and guide to management of caustic ingestions. The degree of esophageal injury at endoscopy is a predictor of systemic complication and death with a 9-fold increase in morbidity and mortality for every increased injury grade. Because of this high rate of complication, prompt evaluation cannot be overemphasized in order to halt development and prevent progression of complications.
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Bonavina L, Chirica M, Skrobic O, Kluger Y, Andreollo NA, Contini S, Simic A, Ansaloni L, Catena F, Fraga GP, Locatelli C, Chiara O, Kashuk J, Coccolini F, Macchitella Y, Mutignani M, Cutrone C, Poli MD, Valetti T, Asti E, Kelly M, Pesko P. Foregut caustic injuries: results of the world society of emergency surgery consensus conference. World J Emerg Surg 2015; 10:44. [PMID: 26413146 PMCID: PMC4583744 DOI: 10.1186/s13017-015-0039-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/15/2015] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Lesions of the upper digestive tract due to ingestion of caustic agents still represent a major medical and surgical emergency worldwide. The work-up of these patients is poorly defined and no clear therapeutic guidelines are available. PURPOSE OF THE STUDY The aim of this study was to provide an evidence-based international consensus on primary and secondary prevention, diagnosis, staging, and treatment of this life-threatening and potentially disabling condition. METHODS An extensive literature search was performed by an international panel of experts under the auspices of the World Society of Emergency Surgery (WSES). The level of evidence of the screened publications was graded using the Oxford 2011 criteria. The level of evidence of the literature and the main topics regarding foregut caustic injuries were discussed during a dedicated meeting in Milan, Italy (April 2015), and during the 3rd Annual Congress of the World Society of Emergency Surgery in Jerusalem, Israel (July 2015). RESULTS One-hundred-forty-seven full papers which addressed the relevant clinical questions of the research were admitted to the consensus conference. There was an unanimous consensus on the fact that the current literature on foregut caustic injuries lacks homogeneous classification systems and prospective methodology. Moreover, the non-standardized definition of technical and clinical success precludes any accurate comparison of therapeutic modalities. Key recommendations and algorithms based on expert opinions, retrospective studies and literature reviews were proposed and approved during the final consensus conference. The clinical practice guidelines resulting from the consensus conference were approved by the WSES council. CONCLUSIONS The recommendations emerging from this consensus conference, although based on a low level of evidence, have important clinical implications. A world registry of foregut caustic injuries could be useful to collect a homogeneous data-base for prospective clinical studies that may help improving the current clinical practice guidelines.
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Affiliation(s)
- Luigi Bonavina
- />Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy
| | - Mircea Chirica
- />Department of Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Ognjan Skrobic
- />Department of Surgery, University of Belgrade, Belgrade, Serbia
| | - Yoram Kluger
- />Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Aleksander Simic
- />Department of Surgery, University of Belgrade, Belgrade, Serbia
| | - Luca Ansaloni
- />General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fausto Catena
- />Emergency Surgery Department, Maggiore Parma Hospital, Parma, Italy
| | - Gustavo P. Fraga
- />Department of Surgery, University of Campinas, Campinas, Brasil
| | - Carlo Locatelli
- />Institute of Toxicology, University of Pavia, Pavia, Italy
| | | | - Jeffry Kashuk
- />Department of Surgery, University of Jerusalem, Jerusalem Rehovot, Israel
| | | | - Yuri Macchitella
- />Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy
| | | | - Cesare Cutrone
- />Department of Otolaryngology, Azienda Ospedaliera, Padova, Italy
| | - Marco Dei Poli
- />Intensive Care Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Tino Valetti
- />Department of Anesthesiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Emanuele Asti
- />Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy
| | - Michael Kelly
- />Department of Surgery, Wagga Wagga Hospital, Wagga Wagga, Australia
| | - Predrag Pesko
- />Department of Surgery, University of Belgrade, Belgrade, Serbia
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Javed A, Agarwal AK. Total laparoscopic esophageal bypass using a colonic conduit for corrosive-induced esophageal stricture. Surg Endosc 2013; 27:3726-3732. [PMID: 23636519 DOI: 10.1007/s00464-013-2956-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 03/29/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND The colon and the stomach are the most commonly used conduits for esophageal replacement in patients with esophageal strictures resulting from corrosive ingestion. The replacement surgeries have traditionally been performed by an open approach. While laparoscopic replacement surgery using a stomach conduit has been previously reported, a total laparoscopic bypass using a colonic conduit has not been previously described. We herein describe the surgical technique and results of laparoscopic esophageal bypass using a colonic conduit. METHODS Patients with corrosive stricture involving the esophagus with the proximal level at the hypopharynx, or those with concomitant gastric scarring, were selected. The surgery was performed with the patient in a supine position using five abdominal ports and a hockey stick/transverse skin crease neck incision. The main steps include colonic mobilization and assessment of the adequacy of the marginal vascular arcade, creation of a retrosternal tunnel, preparation of the colonic conduit, neck dissection, delivery of the colonic conduit into the neck and cervical pharyngo/esophagocolic anastomosis, and intra-abdominal cologastric and ileocolic anastomosis. RESULTS During the study period, 39 patients with corrosive stricture of the esophagus were managed surgically at our center with either gastric or colonic bypass. Of these, 22 patients underwent an open procedure (12 retrosternal colonic bypasses and 10 retrosternal gastric bypasses) and 17 patients underwent a laparoscopic procedure (13 retrosternal gastric bypasses and 4 retrosternal colonic bypasses). Patients with stricture at the hypopharynx (n = 2) or those in whom the stomach was contracted (n = 2) were considered for a laparoscopic esophagocoloplasty. The average duration of surgery of these latter four patients was 370 (380, 320, 360, and 420) min and the mean estimated blood loss was 100 mL. All patients could be ambulated on the first postoperative day and were allowed oral liquids by the 7th postoperative day. Compared with patients who underwent an open colonic bypass, there was significantly less need for analgesics. At a median follow-up of 5 (range 3-6) months, all patients are euphagic to solid diet and have excellent cosmetic results. CONCLUSION Laparoscopic colonic bypass is an achievable, safe, and effective procedure for the management of corrosive strictures of the esophagus.
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Affiliation(s)
- Amit Javed
- Department of GI Surgery, GB Pant Hospital and MAM College, Delhi University, New Delhi, 110002, India
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Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol 2013; 19:3918-3930. [PMID: 23840136 PMCID: PMC3703178 DOI: 10.3748/wjg.v19.i25.3918] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/24/2013] [Accepted: 04/27/2013] [Indexed: 02/07/2023] Open
Abstract
Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developing countries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.
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The role of ultrasound and computed tomography in the evaluation of subcutaneous esophageal bypass in a dysphagic patient. Case Rep Pathol 2013; 2012:827567. [PMID: 23346441 PMCID: PMC3546446 DOI: 10.1155/2012/827567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 12/13/2012] [Indexed: 11/18/2022] Open
Abstract
Several conditions require subcutaneous colon bypass surgery in the esophageal diseases treatment. Esophageal reconstructions are high risk procedures because of their morbidity and mortality rate. Cervical anastomotic strictures, colon transplant redundancy, recurrent dysphagia, intestinal obstruction, regurgitation, and aspiration are the most frequent late complications. The patient assessment should be performed with noninvasive methods in order to prevent long-term complications. We report the use of ultrasound (US) and computed tomography (CT) for evaluating a dysphagic patient, after subcutaneous esophageal bypass. A thorax and upper abdomen contrast media CT study with volume rendering reconstruction was performed in order to evaluate late post operative complications. In addition a US examination, performed after CT scan, was used for the assessment of the colonic wall and its vascularization. The subcutaneous esophageal bypass allowed for an effective ultrasound evaluation with no additional discomfort for the patient. ultrasonography has been shown effective in the esophageal bypass follow up, when subcutaneous colon bypass surgery was performed. The ultrasonography evaluation, also thanks to a Doppler flowmetry, allowed completing the patient assessment without additional invasive procedures or contrast. Thus it may be performed as a first level evaluation or in the follow up of subcutaneous esophageal bypass patients.
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Javed A, Agarwal AK. Laparoscopic retrosternal bypass for corrosive stricture of the esophagus. Surg Endosc 2012; 26:3344-3349. [PMID: 22552862 DOI: 10.1007/s00464-012-2307-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 04/02/2012] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Surgical management of corrosive stricture of the esophagus entails replacement of the scarred esophagus with a gastric or colonic conduit. This has traditionally been done using the conventional open surgical approach. We herein describe the first ever reported minimally invasive technique for performing retrosternal esophageal bypass using a stomach conduit. METHODS Patients with corrosive stricture involving the esophagus alone with a normal stomach were selected. The surgery was performed with the patient in supine position using four abdominal ports and a transverse skin crease neck incision. Steps included mobilization of the stomach and division of the gastroesophageal junction, creation of a retrosternal space, transposition of stomach into the neck (via retrosternal space), and a cervical esophagogastric anastomosis. RESULTS Four patients with corrosive stricture of the esophagus underwent this procedure. The average duration of surgery was 260 (240-300) min. All patients could be ambulated on the first postoperative day and were allowed oral liquids between the fifth and seventh day. At mean follow-up of 6.5 (3-9) months, all are euphagic to solid diet and have excellent cosmetic results. CONCLUSIONS Laparoscopic bypass for corrosive stricture of the esophagus using a gastric conduit is technically feasible. It results in early postoperative recovery, effective relief of dysphagia, and excellent cosmesis in these young patients.
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Affiliation(s)
- Amit Javed
- Department of Gastrointestinal Surgery, GB Pant Hospital and Maulana Azad Medical College, Delhi University, New Delhi, India
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Javed A, Pal S, Krishnan EK, Sahni P, Chattopadhyay TK. Surgical management and outcomes of severe gastrointestinal injuries due to corrosive ingestion. World J Gastrointest Surg 2012; 4:121-5. [PMID: 22655126 PMCID: PMC3364337 DOI: 10.4240/wjgs.v4.i5.121] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 01/20/2012] [Accepted: 01/27/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To report our experience in the surgical management of severe injuries of the gastrointestinal tract due to corrosive ingestion.
METHODS: A retrospective review of patients who underwent emergency surgery for severe gastrointestinal injuries following corrosive ingestion between 1983 and 2010 was carried out. Data was extracted from a prospectively maintained esophageal disease database. Severe corrosive injuries were defined as full thickness necrosis with perforation of the esophagus or the stomach (with or without involvement of the adjacent viscera) with resultant mediastinitis or peritonitis.
RESULTS: Between 1983 and 2010, 209 patients with corrosive injury of the esophagus were managed. Of these, 13 (6.2%) patients underwent emergency surgery for severe corrosive injury. The median age of the patients was 22 years and the median interval between ingestion of the corrosive substance and surgery was 24 h. The surgical procedures done included esophagogastrectomy alone (n = 6), esophagogastrectomy with duodenectomy (n = 4), esophagogastrectomy with pancreaticoduodenectomy (n = 1), esophagogastrectomy with splenectomy (n = 1) and distal gastrectomy with duodenectomy (n = 1). Two patients died in the postoperative period and one after discharge awaiting the second surgery. The factors significantly predictive of mortality following such an injury included renal failure at the time of initial presentation, presence of metabolic acidosis, delay of more than 24 h between corrosive ingestion and surgery, and corrosive induced adjacent organ injury (pancreatic) (P < 0.001, 0.02, 0.005 and 0.015 respectively). Ten patients underwent subsequent surgery for restoration of the alimentary tract continuity with a colonic pull-up (n = 8) and gastrojejunostomy (n = 1). In one patient, the attempted colon pull-up failed due to extensive scarring of the mesocolon. The median follow up (following restoration of continuity of the gastrointestinal tract) was 36.5 mo. One patient developed dysphagia due to a stricture at the anastomotic site, which was successfully managed by dilatation. Another patient developed severe aspiration, necessitating laryngeal inlet closure and permanent tracheostomy, and 3 patients complained of occasional regurgitation.
CONCLUSION: Management of severe corrosive injury involves prompt resuscitation and urgent surgical debridement. Although the subsequent restoration of continuity may be complicated and may not always be possible, long term outcomes are acceptable in the majority.
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Affiliation(s)
- Amit Javed
- Amit Javed, Sujoy Pal, Elan Kumaran Krishnan, Peush Sahni, Tushar Kanti Chattopadhyay, Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi 110029, India
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