Caustic esophageal stricture from diagnosis untill cure

Abstract

Background: The diagnosis of esophageal stricture after caustic ingestion is based on clinical symptoms of dysphagia, regurgitation and chocking that is evident initially in the acute stage. These symptoms may ameliorate by time or proceed to evident stricture due to fibrosis. This will need either dye esophagogram or Esophagoscopy which is better to be done not before the lapse of at least 6 weeks from injury. Esophageal dilatation using wire-guided dilators is the cornerstone of treatment. The frequency of dilatation is based on recurrence of dysphagia and in multiple strictures, repeated sessions with multi-level injection of steroids and graded dilatation is needed. Failure of dilatation or occurrence of complications may necessitate esophageal replacement and usually we prefer the transverse colon based on the left colic vessels in retrosternal position to treat the condition. We aimed to review the management of caustic esophageal strictures based on what is known and adding our experience in this aspect.

Methods: We reviewed the articles discussing management of caustic esophageal strictures in the last twenty years. We added our experience of more than forty years managing an average of thirty new cases every year.

Results: Management of caustic esophageal strictures has changed in the last years. Advanced endoscopic techniques of dilatation reduced the need for esophageal replacement.

Conclusions: Caustic esophageal strictures could be managed successfully with advanced techniques of endoscopic dilatation.

Keywords: Caustic stricture; esophageal dilatation; esophagoscopy; esophageal replacement