Caustic Esophagitis and Gastrofiberoscopy in Children

Kim, Hyeon Jeong; Seo, Jeong Kee

Abstract

PURPOSE
There have been many accidental ingestions of strong acid or alkali in early childhood. If the patient survives the acute effects of caustic ingestion, the reparative response can result in esophageal and gastric stenosis. However there have been few endoscopic studies on caustic esophagitis in children. The aim of this study was to review the contribution of the endoscopy to the diagnosis and management of eosphageal stricture and to search for the guidline of the proper management.
METHODS
We carried out the retrospective study on 15 children who admitted to Seoul National University Children's Hospital after accidental ingestion of caustic agents from the March 1990 to July 1995. They all underwent flexible gastrofiberoscopy to predict the complication of the caustic esophagitis.
RESULTS
The early gastrofiberoscopy showed that the 2nd degree esophageal injury was most common and the majority of patients had diffuse, not localized esophagitis. The incidence of the late occurance of the esophageal stenosis was higher in patients who showed more severe degree of the esophageal mucosal damage on the early endoscopic examination. After the detection of esophageal stenosis on follow up esophagographic examination, 7 children were initially managed with balloon dilatation : Only 2 of them were successfully treated and 5 of them showed poor response to dilatation and finally treated with surgical correction. One child was successfully treated with surgical correction without trial of esophageal balloon dilatation. One child with mild esophageal stenosis improved clinically with supportive care only including antibiotics, steroid therapy, hyperalimentation etc.
CONCLUSIONS
The early gastrofiberoscopic examination immediately after the accident is essential for predicting the late occurance of the esophageal stenosis. Esophageal stenosis could be successfully treated with esophageal balloon dilatation and/or surgical correction with caustic esophagitis in childtren.