Surgical management of upper cervical esophagus stricture caused by ingestion of corrosive substances – a single-center experience
DOI:
https://doi.org/10.15584/ejcem.2024.1.16Keywords:
corrosive injury of the esophagus, dilatation, esophageal replacement surgery, esophageal strictureAbstract
Introduction and aim. Corrosive strictures of the upper cervical esophagus and hypopharynx are hard to treat in the operating room because there is a high chance of aspiration during swallowing after a high-up or proximal esophageal anastomosis. In this cases, we aimed to evaluate the role of intraoperative dilatation of the proximal hypopharyngeal and cervical esophageal stumps during surgery.
Material and methods. Patients who underwent surgery and had upper cervical esophageal and hypopharyngeal strictures from corrosive substance ingestion were included.
Results. Out of total 27 patients, 10 had a cricopharyngeal or proximal cervical esophageal stricture with a long segment tho racic esophageal stricture that was treated with intra-operative dilatation (IOD) of the proximal hypopharyngeal stump. IOD was done in two cases with Hegar’s dilator and in three cases with wire-guided Savary Gillard dilators. In 74% (20/27) of the cases, the colon was frequently used as an esophageal substitute, while the stomach was only used in 10 cases. On follow-up, none of them developed repeated aspirations or required a tracheotomy.
Conclusion. IOD of the proximal hypopharyngeal and cervical esophageal stumps during surgery for corrosive upper cervi cal esophageal or cricopharyngeal strictures helps to save the proximal stump and avoid frequent hospital stays and multiple surgeries.
Downloads
References
Ananthakrishnan N, Subbarao KS, Parthasarathy G, Kate V, Kalayarasan R. Long Term Results of Esophageal Bypass for Corrosive Strictures without Esophageal Resection Using a Modified Left Colon Esophagocoloplasty-A Report of 105 Consecutive Patients from a Single Unit Over 30 Years. Hepatogastroenterology. 2014;61(132):1033-1041.
Gupta NM, Gupta R. Transhiatalesophageal resection for corrosive injury. Ann Surg. 2004;239(3):359-363. doi: 10.1097/01.sla.0000114218.48318.68
Jiang YG, Lin YD, Wang RW, et al. Pharyngocolonic anastomosis for esophageal reconstruction in corrosive esophageal stricture. Ann Thorac Surg. 2005;79(6):1890-1894. doi: 10.1016/j.athoracsur.2004.12.046
Wu MH, Tseng YT, Lin MY, Lai WW. Esophageal reconstruction for hypopharyngoesophageal strictures after corrosive injury. Eur J Cardiothorac Surg. 2001;19(4):400-405. doi: 10.1016/s1010-7940(01)00614-5
Kamat R, Gupta P, Reddy YR, Kochhar S, Nagi B, Kochhar R. Corrosive injuries of the upper gastrointestinal tract: A pictorial review of the imaging features. Indian J Radiol Imaging. 2019;29(1):6-13. doi: 10.4103/ijri.IJRI_349_18
Meena BL, Narayan KS, Goyal G, Sultania S, Nijhawan S. Corrosive injuries of the upper gastrointestinal tract. J Dig Endosc.2017;8:165-169.doi: 10.4103/jde.JDE_24_16
Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol. 2013;19(25):3918-3930. doi: 10.3748/wjg.v19.i25.3918
Nagi B, Kochhar R, Thapa BR, Singh K. Radiological spectrum of late sequelae of corrosive injury to upper gastrointestinal tract. A pictorial review. Acta Radiol. 2004;45(1):7-12. doi: 10.1080/02841850410003329
Rajabi MT, Maddah G, Bagheri R, Mehrabi M, Shabahang H, Lorestani F. Corrosive injury of the upper gastrointestinal tract: review of surgical management and outcome in 14 adult cases. Iran J Otorhinolaryngol. 2015;27(78):15-21.
Litovitz TL, Smilkstein M, Felberg L, Klein-Schwartz W, Berlin R, Morgan JL. 1996 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 1997;15(5):447-500. doi: 10.1016/s0735-6757(97)90193-5
Kurunkar SR, Prabhu RY, Kantharia C, Pujari S, Chaudhari V, Supe A. Corrosive pharyngoesophageal stricture – A challenge to surgeon: A tertiary center experience. Saudi Surg J. 2018;6:41-50.
Schaffer SB, Hebert AF. Caustic ingestion. J La State Med Soc. 2000;152:590-596.
de Jong AL, Macdonald R, Ein S, Forte V, Turner A. Corrosive esophagitis in children: a 30-year review. Int J Pediatr Otorhinolaryngol. 2001;57(3):203-211. doi: 10.1016/s0165-5876(00)00440-7
López Vallejos P, García Sánchez MV, Naranjo Rodríguez A, et al. Endoscopic dilatation of caustic esophageal strictures. Gastroenterol Hepatol. 2003;26(3):147-151. doi: 10.1016/s0210-5705(03)79062-1
Yannopoulos P, Lytras D, Paraskevas KI. Esophageal reconstruction with intraoperative dilatation of the hypopharynx for the management of chronic corrosive esophageal strictures. A technical tip. Eur J Cardiothorac Surg. 2006;30(6):940-942. doi: 10.1016/j.ejcts.2006.09.007
Ananthakrishnan N, Kate V, Parthasarathy G. Therapeutic options for management of pharyngoesophageal corrosive strictures. J Gastrointest Surg. 2011;15(4):566-575. doi: 10.1007/s11605-011-1454-5
Gambardella C, Allaria A, Siciliano G, et al. Recurrent esophageal stricture from previous caustic ingestion treated with 40-year self-dilation: case report and review of literature. BMC Gastroenterol. 2018;18(1):68. doi:10.1186/s12876-018-0801-3
Han Y, Cheng QS, Li XF, Wang XP. Surgical management of esophageal strictures after caustic burns: a 30 years of experience. World J Gastroenterol. 2004;10(19):2846-2849. doi: 10.3748/wjg.v10.i19.2846
Helardot P. Caustic burns of the esophagus, esophagectomy and replacement with gastric tube: comparative study with other procedures. Saudi Med J. 2003;24:39.
Kim YT, Sung SW, Kim JH. Is it necessary to resect the diseased esophagus in performing reconstruction for corrosive esophageal stricture? Eur J Cardiothorac Surg. 2001;20(1):1-6. doi: 10.1016/s1010-7940(01)00747-3
Davids PH, Bartelsman JF, Tilanus HW, van Lanschot JJ. Consequences of caustic damage of the esophagus. Ned Tijdschr Geneeskd. 2001;145(44):2105-2108.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 European Journal of Clinical and Experimental Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our open access policy is in accordance with the Budapest Open Access Initiative (BOAI) definition: this means that articles have free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from having access to the Internet itself.
All articles are published with free open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0). If you submit your paper for publication by the Eur J Clin Exp Med, you agree to have the CC-BY license applied to your work. Under this Open Access license, you, as the author, agree that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. This facilitates freedom in re-use and also ensures that Eur J Clin Exp Med content can be mined without barriers for the research needs.
