TREATMENT OF ESOPHAGEAL STRICTURE DUE TO CORROSIVE SUBSTANCE INGESTION

Objective: Corrosive substance ingestion produces chemical burns on contact with tissues. Depending on the depth and the extent of injuries, progressive narrowing of the esophagus or stomach may occur during wound healing. These strictures may become a chronic problem, requiring repeated dilatations or surgical repair. There is little information on endoscopic balloon-dilatation efficacy and safety in the treatment of corrosive esophageal stricture. We report the results of our experience with the technique. Case Series: Esophageal stricture developed in 9 patients (19%) of 47 cases hospitalized due to grade II-III corrosive burns. In 8 patents the stricture developed following suicidal acid ingestion, and one was secondary to alkali ingestion. The stricture appeared clinically 3 weeks to 3 months post-ingestion. At the time of diagnosis, the stricture was long and dense in 2 patients, so esophagocoloplasty was necessary. Seven patients were treated by the endoscopic balloon-dilatation. The diameter of the initial balloon was 8-12 mm. After the successful first dilatation, the interval between dilatations was 1-4 weeks. Progressive widening of the esophageal lumen to 15 mm, was achieved by 3-7 repeated dilatations. Treatment was successful in 5 patients with annular or short tubular stricture, and they currently eat regular diets. Stricture was undilatable in 2 patients. The reason for the poor result in one patient was probably late initiation of the treatment (2 months post-ingestion). In the second case, after the initial successful dilatation, the stricture developed progressively, and despite the repeated dilations, we could not achieve satisfactory widening of the esophageal lumen. We performed a total of 27 dilatations in 7 patients without any complication. Conclusion: Endoscopic balloon-dilatation is safe and efficient, and could be the treatment of choice in the case of esophageal stricture caused by corrosive injury. We point out that it should be started expeditiously, sometimes a few weeks post-ingestion, before the stricture becomes clinically manifested.
Jovic-Stosic J, Babic G, Todorvic V, Lukacevic S, Bozovic C. National Poison Control Centre, Clinic of Gastroenterology, Military Medical Academy, Belgrade, [...]