Conservative treatment of caustic oesophageal injuries in children: 15 years of experience in a tertiary care paediatric centre

INTRODUCTION: Endoscopic dilatation is good choice of conservative treatment for caustic digestive tract injuries in children. AIM: To set up a strategy of management of caustic digestive tract injury based on our experience and literature review. MATERIAL AND METHODS: We retrospectively analysed medical records of 34 paediatric patients who were admitted to the Centre of Paediatric Surgery of the Children’s Hospital between 2000 and 2017. Age at presentation, gender, anatomic location, circumstances and distribution of injury, early and late complications, clinical signs, and the first aid were analysed. Upper gastrointestinal (GI) endoscopy was performed within 12–24 h after ingestion in all cases. The Zargar classification system was used to grade the severity of the injury. Fisher’s exact test was used for statistical analysis, with p < 0.05 considered as the limit of statistical significance. RESULTS: The upper GI endoscopy revealed caustic injuries in 5 (15%) and 8 (23%) patients were classified as grade IIa and IIb, respectively. Oesophageal and ventricle caustic injuries in 3 (9%) and 2 (6%) patients were classified as grade IIIa and IIIb, respectively. Thirteen patients with grade IIa and IIIb injuries suffered permanent damage and required repeated dilatation. All patients underwent stricture treatment using late or early endoscopic dilatation of the oesophagus. An average of 15 dilatation procedures were required to achieve a satisfactory lumen. CONCLUSIONS: Our experience of 34 children revealed that endoscopic dilatation may be required as a primary treatment for oesophageal strictures.