Conservative treatment of caustic esophageal injuries in children: 20 years of experience

The authors present their experience in the medical treatment of 1,296 caus tic esophageal injuries in children over the last 20 years in two study gro ups, one comprising the period up to 1989 and the other 1990 to 1996, compa ring the different treatments used in each group. The treatment was based f undamentally on dilatations with anterograde mercury bougies, Savary bougie s, or retrograde thread-guided bougies with gastrostomy. Pneumatic balloons or stenting procedures have also been employed in the last 3 years. Early fiberendoscopy was used systematically in the second group, which provides a more accurate evaluation of the esophageal lesions. Antibiotic coverage w as done systematically during the first 10 days in all serious cases, while steroids were employed routinely only in the last 3 years. The results wer e similar in both groups, with a dilatation average of 32 in the first and 30 in the second group and an initial dilatation interval of 3 to 4 weeks i n both. Using updated exploration and dilatation techniques, we drastically reduced the number of gastrostomies needed for retrograde thread-guided di latations from 51 in the first group to 5 in the second, consequently impro ving the patients' life quality. There was no mortality and only five esoph ageal perforations, which did not require surgical treatment.