Corrosive upper gastrointestinal strictures in children:Difficulties and dilemmas  

作　　者：Moinak Sen Sarma Parijat Ram Tripathi Sachin Arora 

机构地区：[1]Department of Pediatric Gastroenterology,Sanjay Gandhi Postgraduate Institute of Medical Sciences,Lucknow 226014,Uttar Pradesh,India [2]Department of Pediatric Gastroenterology,Ankura Hospsital for Women and Children,Hyderabad 500072,Telangana,India [3]Department of Surgical Gastroenterology,Sanjay Gandhi Postgraduate Institute of Medical Sciences,Lucknow 226014,Uttar Pradesh,India

出　　处：《World Journal of Clinical Pediatrics》2021年第6期124-136,共13页世界临床儿科杂志

摘　　要：Children constitute 80%of all corrosive ingestion cases.The majority of this burden is contributed by developing countries.Accidental ingestion is common in younger children(<5 years)while suicidal ingestion is more common in adolescents.The severity of injury depends on nature of corrosive(alkali or acid),pH,amount of ingestion and site of exposure.There are multiple doubts and dilemmas which exist in management of both acute ingestion and chronic complications.Acute ingestion leads to skin,respiratory tract or upper gastrointestinal damage which may range from trivial to life threatening complications.Esophagogastroduodenoscopy is an important early investigation to decide for further course of management.The use of steroids for prevention of stricture is a debatable issue.Upper gastrointestinal stricture is a common longterm sequelae of severe corrosive injury which usually develops after three weeks of ingestion.The cornerstone of management of esophageal strictures is endoscopic bougie or balloon dilatations.In case of resistant strictures,newer adjunctive therapies like intralesional steroids,mitomycin and stents can be utilized along with endoscopic dilatation.Surgery is the final resort for strictures resistant to endoscopic dilatations and adjunctive therapies.There is no consensus on best esophageal replacement conduit.Pyloric strictures require balloon dilatation,failure of which requires surgery.Patients with post-corrosive strictures should be kept in long term follow-up due to significantly increased risk of carcinoma.Despite all the endoscopic and surgical options available,management of corrosive stricture in children is a daunting task due to high chances of recurrence,perforation and complications related to poor nutrition and surgery.

关 键 词：Corrosive STRICTURE CHILDREN Endoscopic dilatation Adjunctive therapy SURGERY 

分 类 号：R725.7[医药卫生—儿科]