ETIOLOGY, CLINICAL PROFILE AND OUTCOME OF ESOPHAGEAL STRICTURES IN CHILDREN
R. Mishra*, M. Das**, S. Gupta***, U.K. Nagar****, V. Bhatia*****, S. Bhatnagar******, N.K.Arora*******
Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, AIIMS, New Delhi *, Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, AIIMS, New Delhi **, Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, AIIMS, New Delhi ***, Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, AIIMS, New Delhi ****, Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, AIIMS, New Delhi *****, Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, AIIMS, New Delhi ******, Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, AIIMS, New Delhi *******
Causes of pediatric esophageal strictures are different from adults and most strictures are amenable to endoscopic dilatation.

Methods: We analysed data of 34 consecutive pediatric patients with a diagnosis of esophageal stricture referred to our center between May 2002 and August 2005. Dilatations were performed initially once every week till a maximum dilatation of 15 mm and 12.8 mm could be achieved in children > 5 years and < 5 years respectively. Secondary interventions were undertaken on recurrence of symptoms. All dilatations were done using Saving Guillard bougie dilators. Response to dilatation was classified as complete (clinical & radiological), partial (only clinical) and no response.

Results: Of the 34 cases, corrosive ingestion was the most frequent etiologic factor (16; 47%). The other etiologic factors were tracheo-esophageal fistula correction surgery (11.8%), associated with gastroesophageal reflux (8.8%), post endoscopic sclerotherapy (5.8%) and congenital syndromes (8.8%). In 17.6% (6/34) cases, etiologic factor could not be determined. Median age at the time of presentation was 46 months (95% CI: 36-48). Children with corrosive ingestion (36 months) and unknown etiology (32.5 months) were much younger at presentation as compared to rest of the patients. Dysphagia (27/34; 79.4%) and vomiting (14/31; 45.2%) were the most frequent symptoms. Patients of corrosive ingestion presented sooner (median: 2 months; 95% CI:1-16.9) as compared to patients in other categories (median: 12 months; 95% CI: 037.9) (FETO.001). Intervention could be analysed in 23 patients; remaining were lost to follow up. A total of 184 sessions of dilatation were performed in these patients as initial intervention with a mean (+ S.D.) of 11.4 (+ 9.5) sessions per patient. Recurrence occurred in 8 (34.8%) patients requiring 68 cumulative sessions of dilatation. No mortality or major complications due to endoscopic dilatation occurred. Minor complications (hematemesis, desaturation and ulceration) occurred in 12/252 (4.8%) sessions. Response was complete in 60.9% (14/23; partial in 21.7% (5/23) and failed in 17.4% (4/23) who were referred for surgery.

Conclusion: Corrosive injury is the major cause of esophageal strictures responding to endoscopic treatment.
How to Cite URL :
Mishra R, Das M, Gupta S, Nagar U, Bhatia V, Bhatnagar S, N.K.Arora.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=225
Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.