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Introduction. Caustic ingestion is a public health problem worldwide, due to a high burden of morbidity, mortality and costs. Therefore, it is essential to have clear knowledge in the adult population, without extrapolating management data from the pediatric population. Methods. A critical review of the available information was carried out in order to establish important data in the management of caustic esophagitis in the adult population, including an analysis of the type of intake, volume, intention and age, to help identify early complications susceptible to surgical management. Results. Endoscopy has an important role in the first 24-48 hours to establish the severity of the damage according to the Zargar classification, which combined with the imaging classification allows a better prognosis to be achieved. There is no demonstrated benefit from the use of PPI, mitomycin C, nasogastric tube or esophageal prosthesis to prevent strictures. Steroids have a benefit in Zargar ≥ 2B (with airway compromise) and there are promising data with the use of sucralfate at high-doses. In complications derived from stenosis, early dilation with Savary-Guillard is preferred. After 10 years of ingestion, endoscopic follow-up should be performed every 2-3 years to screen for esophageal squamous cell cancer. Conclusion. Caustic esophagitis is a condition with a high morbidity burden, whose prognosis depends on early interventions and multidisciplinary management and follow-up. [ABSTRACT FROM AUTHOR]

Introduction. Esophageal burns caused by caustic ingestion have as a late complication the formation of strictures, which prevents adequate feeding due to the impossibility of passing food. To correct this complication, esophageal replacement can be performed surgically by forming a gastric tube. Clinical case. We present the case of a pediatric patient with esophageal stricture caused by accidental ingestion of caustics, which could not be resolved by endoscopic esophageal dilations. It was decided to proceed with the formation of a "flexible" gastric tube, since is longer, preserves a better vascular supply and decreases the risk of anastomotic leak generated by ischemic sites. Result. Two days after surgery, an esophagogastroduodenal series with water-soluble contrast was performed, where no leaks were observed. Subsequently, on the third postoperative day, the patient began to eat solids. Conclusion. The surgical technique used to form this gastric tube allows adequate vascular permeability, avoiding leaks at the anastomosis sites. [ABSTRACT FROM AUTHOR]

Introduction. Endoscopic esophageal dilation is an effective therapeutic option for the treatment of esophagus strictures and motor disorders. To perform it, it is essential to know the etiology and anatomy of the injury and to have clinical experience. These factors determine the indication and development of the procedure. The objective of this study was to report the experience in the management of patients with esophageal stricture at a reference center institution for digestive diseases in Bogotá, D.C., Colombia. Methods. A descriptive, retrospective cohort study was carried out, in which patients undergoing esophageal dilation by the Gastroenterology Service were evaluated, from January 2021 to June 2023. All patients over 18 years of age with esophageal stenosis of any etiology and achalasia were included. Results. 27 patients were identified, 92.6% men. The most prevalent etiology was post-surgical stenosis (40.7%), followed by achalasia (29.6%), gastroesophageal reflux disease (18.5%), and inflammatory diseases (11.1%). The 'rule of three' was safely used in postsurgical and peptic strictures. The majority of the dilations (81.5%) were successful and a single complication of esophageal perforation occurred. Conclusion. Endoscopic dilation is a safe procedure for the treatment of esophageal stenosis and achalasia. Correct procedure indication, type of stenosis, appropriate choice of dilator and professional expertise are crucial aspects for the effectiveness of this technique and for the detection and management of potential complications. [ABSTRACT FROM AUTHOR]

Objective. To analyze the efficacy of intralesional steroid treatment in refractory caustic esophageal stricture. Materials and methods. An analytical, retrospective study of patients receiving intralesional steroid treatment with triamcinolone acetonide as a result of refractory caustic esophageal stricture was carried out. Demographic variables, stricture characteristics, number of dilations, steroid injections, and dilation score (no. of dilations/ follow-up period in months) pre- and post-treatment were collected. Stricture characteristics (diameter and length) and dilation score preand post-treatment were compared using the T-Test or Wilcoxon test. Results. N= 5. Median age: 5 years (17 months-7 years). Follow-up: 6.60 ± 2.70 years. Swallowed products included NaOH, KOH, and ClH. Zargar classification at follow-up initiation was IIb (n= 2), IIIa (n= 1), and two chronic strictures. 6.6 ± 9.23 esophageal dilations were carried out before steroid treatment initiation. The mean number of intralesional therapy sessions was 11.20 ± 6.14. Stricture length decreased by 3.60 ± 2.63 cm (t= 3.06; p= 0.019). No differences were found in terms of diameter increase: –1.60 ± 3.58 mm (t= –1.00; p= 0.187). The dilation score diminished from 1.47 ± 0.86 to 0.47 ± 0.18 dilations per month of follow-up (Z= –2.02; p= 0.043). Conclusions. Even though there is limited evidence available in the pediatric population, intralesional triamcinolone treatment is seemingly useful in the treatment of refractory caustic esophageal stricture, since it reduces length and dilation score. [ABSTRACT FROM AUTHOR]

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Introducción. La ingesta de cáusticos continúa siendo un problema de salud pública en los países en vía de desarrollo, por lo que a veces es necesario realizar un reemplazo esofágico en estos pacientes. Aún no existe una técnica estandarizada para este procedimiento. Caso clínico. Masculino de 10 años con estenosis esofágica por ingesta de cáusticos, quien no mejoró con las dilataciones endoscópicas. Se realizó un ascenso gástrico transhiatal por vía ortotópica mediante cirugía mínimamente invasiva como manejo quirúrgico definitivo. Discusión. Actualmente existen varios tipos de injertos usados en el reemplazo esofágico. La interposición colónica y gástrica son las que cuentan con mayores estudios, mostrando resultados similares. Conclusiones. La elección del tipo y posición del injerto debe ser individualizada, tomando en cuenta las características de las lesiones y la anatomía de cada paciente para aumentar la tasa de éxito.

Introduction: Chemical substances are important causes of gastrointestinal tract injuries and usually affect two groups of patients: children under 5 years of age and adults who attempt suicide. Its effects can range from necrosis to perforation of the digestive tract, which can affect the mouth, pharynx, esophagus and stomach. The main complication of accidental caustic ingestion is esophageal stricture. The frequency with which esophageal strictures appear ranges from 15% to 35% and is related to the degree of injury induced by the ingested agent. They may become symptomatic by the second or third week after a latent repair phase or, in other cases, months or years after ingestion. Different forms of treatment have been applied to treat caustic esophageal strictures, and endoscopic dilation is the first line, with successful results in 60% to 80% of patients. If these are not effective, surgical treatment for esophageal replacement is indicated. Clinical Case: A clinical case of a 48-year-old male patient with no chronic degenerative history is presented, who began suffering after accidental ingestion of caustic substance 4 months ago with dysphagia to liquids and solids, for which he is protocolized in our unit for definitive surgical resolution by gastric pull-up. Conclusions: Although associated with high rates of anastomotic stricture, transhiatal esophagectomy and gastric pull-up with cervical anastomosis are safe procedures for the treatment of caustic esophageal strictures. [ABSTRACT FROM AUTHOR]

Aim: To describe the results of esophageal replacement surgery with an inverted gastric tube via retrosternal ascent in two pediatric hospitals during the period March 2015 to March 2018. Materials and Method: an observational, cross-sectional study with retrospective data collection that included all the records of patients with esophageal discontinuity due to acquired or congenital causes who underwent esophageal replacement surgery with an inverted gastric tube in two pediatric hospitals for 3 years. Results: We found 29 children undergoing esophageal replacement, of which 27 met inclusion criteria. The age between 2 to 17 years. 63% corresponds to the female sex. The most frequent cause of esophageal replacement is esophageal stricture due to caustic ingestion (92.59%). 70% presented some type of complication after surgery. The esophagocutaneous fistula is the main complication with 33.33%. The stay in the intensive care unit is less than 24 hours in 74% of children. The oral route is started in almost half of cases between 10-12 days after surgery; the hospital stay is on average 18.5 days. Mortality is 3.70%. Conclusion: The esophageal substitution by inverted gastric tube via retrosternal ascent is a technique comparable in results to the interposition of the colon. For the authors, the stomach is an ideal organ to perform esophageal reconstruction, and its complications are manageable. [ABSTRACT FROM AUTHOR]