Experience of endoscopy in patients with gastrointestinal stenosis after caustic ingestion

Yıl 2019, , 85 - 88, 25.12.2019

Mustafa Kaplan , Bülent Ödemiş Selçuk Dişibeyaz Erkan Parlak , Volkan Gökbulut , Adem Aksoy Orhan Coşkun , Muhammet Akpınar

https://doi.org/10.17940/endoskopi.673829

Öz

Background and Aims: This study investigated the etiologic causes, stenosis locations, and endoscopic treatment options of caustic gastrointestinal injury. Material and Methods: This study was performed retrospectively, with 41 patients who were treated endoscopically for stenosis caused by caustic damage between 2005 and 2015. Data such as patients’ demographic characteristics, surgical information, ingested material, and stenosis locations were obtained from their medical records. Results: This study comprised 41 patients. The mean age of patients was 32±9.2 years. Of these, 25 patients were males (61%), and 16 were females (39%). The median number of endoscopy procedures was 9 and ranged from 1 to 32. The most common cause of caustic damage was ozone water (19%), degreasers (15%), and descaling agents (15%). Endoscopic examination revealed stenosis in the middle esophagus (41%), but less frequently in the proximal esophagus (19%), distal esophagus (19%), anastomosis (10%), and the entire esophagus (7%). Six patients were operated for strictures (15%). Savary-Gilliard and balloon dilatation were the most frequently applied treatments. Two patients had local steroid injections, and two had stents. Conclusion: Esophageal stenosis because of caustic ingestion develops most frequently by ingesting cleaning agents and most commonly involves the middle part of the esophagus, with the most commonly used treatment options being balloon and Savary-Gilliard dilatation.

Anahtar Kelimeler

Esophageal stenoses, Savary-Gilliard dilatation, balloon dilatation

Kostik madde içimi sonrası gastrointestinal darlık gelişen hastalarda endoskopi tecrübemiz

Öz

Giriş ve Amaç: Bu çalışmada gastrointestinal kostik yaralanma sonrası endoskopik tedavi uygulanan hastaların etiyolojik nedenlerini, darlık yerlerini ve uygulanan tedavileri araştırdık. Gereç ve Yöntem: Bu çalışma 2005-2015 yılları arasında kostik hasara bağlı darlık nedeniyle endoskopik olarak tedavi edilen 41 hasta ile retrospektif olarak yapılmıştır. Hastaların demografik özellikleri, ameliyat bilgileri, ne içtikleri ve darlık yerleri dosyalarından kaydedilmiştir. Bulgular: Bu çalışma 41 hasta ile yapılmıştır. Hastaların ortalama yaşı 32±9.2 idi. Hastaların 25’i erkek (%61), 16’sı ise kadındı (%39). Hastaların median işlem sayısı 9 olup, işlem sayısı 1 ile 32 arasında değişmekteydi. Kostik hasarın en sık sebebi ozon suyu (%19), yağ çözücü (%15) ve kireç çözücü (%15) idi. Endoskopik incelemede darlıklar en sık orta özofagusta (%41) görülmekle birlikte daha az sıklıkla proksimal özofagus (%19), distal özofagus (%19), anastomoz (%10) ve tüm özofagusta (%7) görülmekteydi. 6 hastanın darlıklar nedeniyle opere edildiği görüldü (%15). Hastalara yapılan terapötik işlemler incelendiğinde en sık buji ve balon dilatasyonu uygulandığı görüldü. İki hastaya lokal steroid enjeksiyonu ve iki hastaya da stent takıldığı görüldü. Sonuç: Kostik madde içimine bağlı özofagus darlığı en sık olarak temizlik maddelerinin içimine bağlı olarak gelişmekte, en sık özofagus orta kısmını tutmakta ve tedavide en sık balon ve buji dilatasyon tedavisi kullanılmaktadır.

Anahtar Kelimeler

Özofagus darlıkları, Savary-Gilliard dilatasyonu, balon dilatasyonu

Kaynakça

• 1. Turner A, Robinson P. Respiratory and gastrointestinal complications of caustic ingestion in children. Emerg Med J 2005;22:359-61
• 2. Gumaste VV, Dave PB. Ingestion of corrosive substances by adults. Am J Gastroenterol 1992;87:1-5
• 3. Bird JH, Kumar S, Paul C, Ramsden JD. Controversies in the management of caustic ingestion injury: an evidence-based review. Clin Otolaryngol 2017;42:701-8.
• 4- Ogunrombi AB, Mosaku KS, Onakpoya UU. The impact of psychological illness on outcome of corrosive esophageal injury. Niger J Clin Pract 2013;16:49-53.
• 5- Park KS. Evaluation and Management of caustic injuries from ingestion of acid or alkaline substances. Clin Endosc 2014;47:301-7.
• 6-Yoon KW, Park MH, Park GS, et al. A clinical study on the upper gastrointestinal tract injury caused by corrosive agent. Korean J Gastrointest Endosc 2001;23:82-7.
• 7- Aydın E, Özcan R, Emre Ş, ve ark. Çocukluk çağında koroziv madde içimi: Altı yüz seksen bir olgunun değerlendirilmesi. Çocuk Cerrahisi Dergisi 2012;26:26-31.
• 8- Niedzielski A, Schwartz SG, Partycka-Pietrzyk K, Mielnik-Niedzielska G. Caustic agents ingestion in children: A 51-year retrospective cohort study. Ear Nose Throat J 2019:145561319843109.
• 9- Dehghani SM, Bahmanyar M, Javaherizadeh H. Caustic ingestion in children in south of Iran: A two-year single center study. Middle East J Dig Dis 2018;10:31-4.
• 10- Maaloul I, Kmiha S, Yaich S, et al. Epidemiology of home accidents in childhood: experience in the Division of General Pediatrics in Southern Tunisia. Pan Afr Med J 2019;33:108.
• 11- Aydın Ç, Açıkalın A, Kozacı N, ve ark. Koroziv Madde Oral Alımı Nedeniyle Başvuran Hastaların Demografik Olarak Değerlendirilmesi. Cukurova Medical Journal 2014;39:271-9.
• 12-Dakkak M, Bennett JR. Comparison between Savary Gilliard and balloon dilatation of benign esophageal strictures. World J Surg 1991;15:667.
• 13-Scolapio JS, Pasha TM, Gostout CJ, et al. A randomized prospective study comparing rigid to balloon dilators for benign esophageal strictures and rings. Gastrointest Endosc 1999;50:13-7.
• 14-Gunnarsson M. Local corticosteroid treatment of caustic injuries of the esophagus. A preliminary report. Ann Otol Rhinol Laryngol 1999;108:1088-90.
• 15-De la Garza González SJ, García RG.Update in the endoscopic management of benign esophageal stenoses. Rev Gastroenterol Mex 2005;70:20-4.
• 16-Nijhawan S, Udawat HP, Nagar P. Aggressive bougie dilatation and intralesional steroids is effective in refractory benign esophageal strictures secondary to corrosive ingestion. Dis Esophagus 2016;29:1027-31.
• 17-Kochhar R, Samanta J, Basha J, et al. Biodegradable stents for caustic esophageal strictures: Do they work? Dysphagia 2017;32:575-82.
• 18-Lu Q, Yan H, Wang Y, et al. The role of endoscopic dilation and stents in refractory benign esophageal strictures: a retrospective analysis. BMC Gastroenterol 2019;19:95.
• 19- Siersema PD. How to approach a patient with refractory or recurrent benign esophageal stricture. Gastroenterology 2019;156:7-10.