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World J Clin Pediatr. Nov 9, 2021; 10(6): 124-136
Published online Nov 9, 2021. doi: 10.5409/wjcp.v10.i6.124
Corrosive upper gastrointestinal strictures in children: Difficulties and dilemmas
Moinak Sen Sarma, Parijat Ram Tripathi, Sachin Arora
Moinak Sen Sarma, Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Parijat Ram Tripathi, Department of Pediatric Gastroenterology, Ankura Hospsital for Women and Children, Hyderabad 500072, Telangana, India
Sachin Arora, Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Author contributions: Sarma MS contributed conceptualisation, intellectual inputs, final drafting; Tripathi PR contributed data retrieval, primary manuscript drafting; Arora S contributed intellectual inputs on surgical aspects.
Conflict-of-interest statement: The authors have no conflict of interest for this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Moinak Sen Sarma, MBBS, MD, Associate Professor, Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India. moinaksen@gmail.com
Received: February 22, 2021
Peer-review started: February 22, 2021
First decision: June 5, 2021
Revised: July 30, 2021
Accepted: September 19, 2021
Article in press: September 19, 2021
Published online: November 9, 2021
Processing time: 259 Days and 11.2 Hours
Abstract

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 long-term 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.

Keywords: Corrosive; Stricture; Children; Endoscopic dilatation; Adjunctive therapy; Surgery

Core Tip: Corrosive ingestion is a life-threatening problem in children. The sequelae are grave and tenacious. There are multiple dilemmas in the acute management of corrosive ingestion. Endoscopic dilatations have challenges and are the cornerstone in management of upper gastrointestinal strictures. Adjunctive therapies may play a pivotal role. Surgery is required in refractory cases.