© Borgis - New Medicine 3/1999, s. 18-19
Małgorzata Dębska, Mieczysław Chmielik, Iwona Jakubczyk
Treatment of post-burn strictures with internal oesophagotomy
Department of Pediatric Otorhinolaryngology, Medical School, Warsaw
Head: Prof. Mieczysław Chmielik, M.D.
107 patients with esophagostenosis after chemical burns were examined. Subjective swallowing ability and condition of esophagus in radiological examination were estimated. It was concluded that internal esophagotomy is a valuable method of fixed esophageal stenosis treatment.
Methods of treatment of post-burn strictures of the oesophagus vary from centre to centre. The aim of this paper is to assess, the long-term effects of the treatment of cicatricial strictures with internal oesophagotomy, following chemical injury in children at a developmental age.
Over a period of 45 years (1950-1995) 107 patients with post-burn strictures (95) or atresia (12) of the oesophagus were diagnosed and treated at the Department of Paediatric Otolaryngology, Warsaw. The subjects included 38 girls and 69 boys who had suffered burns of the oesophagus in early childhood (mean age 4.06 years).
Thirty-five subjects were assessed i.e. 35 women and 22 men who came to follow-up after treatment of after-burn oesophageal strictures with internal incision. Out of these, 32 patients had been treated with internal oesophagotomy only, whereas 3 subjects (1 female and 2 males) had undergone intestinal oesophagoplasty. The patients´ ages ranged from 9 to 53 years, the mean age being 33.94 years. The study patients presented at different times on completion of their treatment and the follow-up period was from 4.5 years to 42 years (mean 24.87 years).
A thorough history, study of medical records, and radiological examination of the oesophagus following a barium swallow provided the grounds for the evaluation attempt of the preferred treatment method of oesophageal stricture employed in our Department. The patients´ self-assessment of their ability to swallow food was graded as follows:
I - good, normal swallowing,
II - moderate, all foods are swallowed but are chewed for longer and swallowing require drinking water,
III - dysphagia, swallowing of mashed foods, experiencing episodes of foreign bodies in the oesophagus.
Patients´ self-assessment of food swallowing
Good, normal swallowing ability (I and II) was reported by 29 subjects (90.63%); 3 patients (9.7%) reported normal food ingestion but admitted having difficulty in swallowing (III). Three patients after oesophagoplasty who denied dysphagia were excluded from the self-assessment of their swallowing ability.
Diameter of oesophageal stricture measured with a bougie prior to treatment
In patients with oesophageal stricture the initial size of a constricted lumen of the oesophagus was measured in millimetres using a bougie and was carried out on the first endoscopic examination. One patient presented with atresia; in 4 patients (11.43%) the oesophagus was constricted to 2 mm, in 27 patients (77.14%) the constriction was 3-4 mm, and in 3 patients (8.7%) it was noted to be up to 5 mm. The mean diameter of the stricture was 3.37 mm.
Diameter of oesophageal stricture measured with a bougie following treatment
The final oesophagoscopy carried out after the last successfull internal oesophagotomy permitted to close gastrostomy over a short-term follow-up.
In 1 case atresia was diagnosed; in 14 patients (40%) the oesophageal lumen increased to 7 mm; in 11 patients (31.43%) the lumen reached an 8 mm diameter and in 6 subjects (17.14%) the diameter increased to 9mm. In 2 patients (5.71%) the treatment was completed after obtaining a 6 mm diameter of the oesophageal lumen.
Following the treatment, the mean diameter of the oesophagus at the site of the stricture was 6.57 mm, which shows that improvement had been obtained by an average of 3.20mm (prior to the treatment the oesophageal lumen had been 3.37mm in diameter).
Radiological evaluation of the present diameter of the oesophageal lumen
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