Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Usefulness of early endoscopy for predicting the development of stricture after corrosive esophagitis in children

소아 부식식도염의 합병증 예측을 위한 조기 내시경 검사의 유용성

  • Park, Ji Yong (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Seo, Jeong-Kee (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Shin, Jee Youn (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Yang, Hye Ran (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Ko, Jae Sung (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Kim, Woo Sun (Department of Radiology, Seoul National University College of Medicine)
  • 박지용 (서울대학교 의과대학 소아과학교실) ;
  • 서정기 (서울대학교 의과대학 소아과학교실) ;
  • 신지연 (서울대학교 의과대학 소아과학교실) ;
  • 양혜란 (서울대학교 의과대학 소아과학교실) ;
  • 고재성 (서울대학교 의과대학 소아과학교실) ;
  • 김우선 (서울대학교 의과대학 영상의학교실)
  • Received : 2008.09.15
  • Accepted : 2008.10.21
  • Published : 2009.04.15
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Abstract

Purpose : This study was performed to demonstrate the usefulness of early endoscopy for predicting the development of stricture following corrosive ingestion in children. Methods : We conducted a retrospective study on 34 children who were brought to Seoul National University Childrens Hospital and Seoul National University Bundang Hospital for corrosive ingestion from 1989 to 2007. Results : The corrosive burns were classified as grade 0 in 8 patients, grade 1 in 2, grade 2a in 7, grade 2b in 13, and grade 3 in 4. There was no significant correlation between the presence of esophageal injury and symptoms including vomiting, dysphagia, and drooling. There was a statistically significant relation between the presence of oropharyngeal injury and esophageal injury (P=0.014). There were no complications including hemorrhage and perforation related to endoscopy. Strictures of the esophagus or the stomach developed in 12 patients (36.4%). Esophageal stricture was observed in 11 patients and pyloric stenosis in 1 patient. The endoscopic grade of mucosal injury was significantly related to the frequency of development of esophageal stricture (P=0.002). Two of eleven patients with esophageal stricture responded to repeated dilation. The remaining seven patients underwent surgery. Conclusion : Early esophagogastroduodenoscopy is not only a safe and useful diagnostic tool for children with accidental caustic ingestion but also a necessity for determining the degree and the extent of caustic burns and for predicting the development of late complications.

목 적 : 소아 부식식도염 환자에서 후기 합병증 예측을 위한 조기내시경 검사의 유용성에 대해서 분석하고자 하였다. 방 법 : 1989년 1월부터 2007년 12월까지 빙초산과 가성소오다 등의 부식성물질 섭취 후 급성기에 서울대학교 어린이병원과 분당서울대학교병원에 내원하여 내시경을 시행한 34명의 환자를 대상으로 내시경 검사와 의무기록 조사 및 보호자 전화면담을 통하여 정보를 수집하였다. 결 과 : 식도의 내시경 소견을 보면 grade 0, grade 1, grade 2a, grade 2b, grade 3인 경우가 각각 8명, 2명, 7명, 13명, 4명이었다. 구토, 침흘림, 삼킴곤란 등의 증상의 유무는 내시경상 식도 점막 손상의 유무와 유의한 상관관계를 보이지 않았다. 구강 손상의 유무는 내시경상 식도 점막 손상의 유무와 유의한 상관관계를 보였다(P=0.014). 내시경 시행 후 점막째짐, 출혈, 천공 등의 합병증은 발생하지 않았다. 협착은 12명(36.3%)의 환아에서 발생하였고, 식도의 협착은 11명, 유문부의 협착은 1명이었다. 식도 점막 손상의 정도가 심해질수록 식도협착이 많이 발생하는 경향을 보였다(P=0.002). 식도협착이 있었던 11명 중 2명(18.1%)은 반복적인 식도확장술만으로 증상이 호전되었고, 나머지 7명(63.6 %)은 수술이 필요하였다. 결 론 : 부식성 물질을 실수로 섭취한 소아에서 내시경 검사는 안전하고 유용한 검사이며, 점막 손상의 정도와 부위를 확인함으로써 후기 합병증 발생 예측에 도움이 되기 때문에 조기에 식도내시경을 시행하는 것이 필요하다.

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References

  1. Olives JP. Injuries of the esophagus. In: Walker WA, Goulet O, Kleinman RE, Sherman PM, Shneider BL, Sanderson IR, editors. Pediatric gastrointestinal disease. 4th ed. Hamilton (ON): BC Decker, 2004:463-80
  2. Ramasamy K, Gumaste VV. Corrosive ingestion in adults. J Clin Gastroenterol 2003;37:119-24 https://doi.org/10.1097/00004836-200308000-00005
  3. Christesen HB. Prediction of complications following unintentional caustic ingestion in children. Is endoscopy always necessary? Acta Paediatr 1995;84:1177-82 https://doi.org/10.1111/j.1651-2227.1995.tb13520.x
  4. Lamireau T, Rebouissoux L, Denis D, Lancelin F, Vergnes P, Fayon M. Accidental caustic ingestion in children: Is endoscopy always mandatory? J Pediatr Gastroenterol Nutr 2001;33:81-4 https://doi.org/10.1097/00005176-200107000-00014
  5. Betalli P, Falchetti D, Giuliani S, Pane A, Dall'Oglio L, de Angelis GL, et al. Caustic ingestion in children: Is endoscopy always indicated? The results of an italian multicenter observational study. Gastrointest Endosc 2008;68:434-9 https://doi.org/10.1016/j.gie.2008.02.016
  6. Dogan Y, Erkan T, Cokugras FC, Kutlu T. Caustic gastroesophageal lesions in childhood: An analysis of 473 cases. Clin Pediatr (Phila) 2006;45:435-8 https://doi.org/10.1177/0009922806289618
  7. Gaudreault P, Parent M, McGuigan MA, Chicoine L, Lovejoy FH, Jr. Predictability of esophageal injury from signs and symptoms: A study of caustic ingestion in 378 children. Pediatrics 1983;71:767-70
  8. Anderson KD, Rouse TM, Randolph JG. A controlled trial of corticosteroids in children with corrosive injury of the esophagus. N Engl J Med 1990;323:637-40 https://doi.org/10.1056/NEJM199009063231004
  9. Kay M, Wyllie R. Caustic ingestions and the role of endoscopy. J Pediatr Gastroenterol Nutr 2001;32:8-10 https://doi.org/10.1097/00005176-200101000-00007
  10. Zargar SA, Kochhar R, Mehta S, Mehta SK. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc 1991;37:165-9 https://doi.org/10.1016/S0016-5107(91)70678-0
  11. de Jong AL, Macdonald R, Ein S, Forte V, Turner A. Corrosive esophagitis in children: A 30-year review. Int J Pediatr Otorhinolaryngol 2001;57:203-11 https://doi.org/10.1016/S0165-5876(00)00440-7
  12. Huang YC, Ni YH, Lai HS, Chang MH. Corrosive esophagitis in children. Pediatr Surg Int 2004;20:207-10 https://doi.org/10.1007/s00383-004-1153-3
  13. Hijazeen R. Corrosive burns of the upper gastrointestinal tract among jordanian children. Ann Saudi Med 1998;18: 173-5
  14. Kim HJ, Seo JK. Caustic esophagitis and gastrofiberoscopy in children. J Korean Pediatr Soc 1996;39:1556-64
  15. Choi DH, Cho MG, Ju HG, Kim BJ, Ma JS. A clinical obser vation on children with corrosive esophagitis. Korean J Pediatr Gastroenterol Nutr 2000;3:1-8
  16. Kirsh MM, Ritter F. Caustic ingestion and subsequent damage to the oropharyngeal and digestive passages. Ann Thorac Surg 1976;21:74-82 https://doi.org/10.1016/S0003-4975(10)64894-1
  17. Cello JP, Fogel RP, Boland CR. Liquid caustic ingestion. Spectrum of injury. Arch Intern Med 1980;140:501-4 https://doi.org/10.1001/archinte.140.4.501
  18. Tam PK, Saing H. Pediatric upper gastrointestinal endoscopy: A 13-year experience. J Pediatr Surg 1989;24:443-7 https://doi.org/10.1016/S0022-3468(89)80398-7
  19. Balsells F, Wyllie R, Kay M, Steffen R. Use of conscious sedation for lower and upper gastrointestinal endoscopic examinations in children, adolescents, and young adults: A twelve-year review. Gastrointest Endosc 1997;45:375-80 https://doi.org/10.1016/S0016-5107(97)70147-0
  20. Previtera C, Giusti F, Guglielmi M. Predictive value of visible lesions (cheeks, lips, oropharynx) in suspected caustic ingestion: May endoscopy reasonably be omitted in completely negative pediatric patients? Pediatr Emerg Care 1990;6: 176-8 https://doi.org/10.1097/00006565-199009000-00002
  21. Rothstein FC. Caustic injuries to the esophagus in children. Pediatr Clin North Am 1986;33:665-74
  22. Wason S. The emergency management of caustic ingestions. Journal of Emergency Medicine 1985;2:175-82 https://doi.org/10.1016/0736-4679(85)90393-2
  23. Gupta SK, Croffie JM, Fitzgerald JF. Is esophagogastroduo denoscopy necessary in all caustic ingestions? J Pediatr Gastroenterol Nutr 2001;32:50-3 https://doi.org/10.1097/00005176-200101000-00015
  24. Zamir O, Hod G, Lernau OZ, Mogle P, Nissan S. Corrosive injury to the stomach due to acid ingestion. Am Surg 1985; 51:170-2
  25. Nuutinen M, Uhari M, Karvali T, Kouvalainen K. Consequences of caustic ingestions in children. Acta Paediatr 1994;83:1200-5 https://doi.org/10.1111/j.1651-2227.1994.tb18281.x
  26. Ferguson MK, Migliore M, Staszak VM, Little AG. Early evaluation and therapy for caustic esophageal injury. The American Journal of Surgery 1989;157:116-20 https://doi.org/10.1016/0002-9610(89)90430-3
  27. Adam JS, Birck HG. Pediatric caustic ingestion. Ann Otol Rhinol Laryngol 1982;91:656-8
  28. Moazam F, Talbert JL, Miller D, Mollitt DL. Caustic ingestion and its sequelae in children. South Med J 1987;80:187-90 https://doi.org/10.1097/00007611-198702000-00012
  29. Wasserman RL, Ginsburg CM. Caustic substance injuries. The Journal of Pediatrics 1985;107:169-74 https://doi.org/10.1016/S0022-3476(85)80119-0