Caustic Esophageal Strictures in Children: Diagnosis, Treatment and Evolution in the City of Douala

Abstract

Background: Pediatric caustic ingestion remains frequent and the formation of esophageal strictures is one it’s most dangerous and major complications. The treatment is usually long and difficult and the success of treatment usually depends on the characteristics of the esophageal stricture. The main purpose of our study was to evaluate the diagnosis, treatment and the evolution of cases of caustic esophageal strictures in children in 3 hospitals of the city of Douala. Methods: It was a retrospective and analytic study conducted at the general hospital of Douala, Laquintie hospital of Douala and the Douala gyneco-obstetric and pediatric hospital of Douala from January, 1 st 2011 to December 31 st 2020, from which we had 31 cases of esophageal strictures post ingestion of caustic substances. Results: Cases of caustic esophageal strictures accounted for 23.7% of caustic ingestions and represented 88.6% of the cases of esophageal strictures in children. The mean age of patients was 3.8±2.1 year with extremes going from 1 to 11 years and 61.3% (n=19) of our patients were aged from 2 to 6 years. The male sex was the most predominant with a sex ratio of 1.6. The ingestion was accidental in all the cases, with caustic soda being the most ingested substance in 32.3% of the cases. Drooling was the most frequent initial sign in 45.2% of the cases and dysphagia developed in 93.5% of patients at the stricture phase. 61.3% of our patients had signs of malnutrition and feeding gastrostomy was done in 64.5% of patients. The upper third esophagus was the most frequent localization in 65.6% of the cases. 64.5% of patients were treated by endoscopic dilation and 9.7% required an esophageal replacement. The average duration of treatment was 11.53±4.6 months; it was significantly shorter for patient with short and passable strictures. Dysphagia, drooling, weight loss and ingestion of alkaline were significantly associated with the formation of esophageal strictures. Conclusion: Cases of caustic substance ingestion remain common in our hospitals; endoscopic dilatation occupies the first place in the treatment of caustic esophageal strictures. Prevention still remains the key treatment in the formation of esophageal strictures.