• Journal of Chest Surgery
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• v.6 no.2
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• pp.225-230
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• 1973

Five cases of esophageal cancer developed at the site of esophageal lye stricture were reported. Duration of lye stricture was between 13 and 40years, and all 5 cases had taken normal diet without appreciable troubles after recovery from the acute stage of burn till the suspected onset of esophageal malignaney. Outstanding symptoms of this grave condition were rather acute progressive dysphagia and frequent episodes of esophageal foreign bodies, Diagnosis could be confirmed easily by endoscopic biopsy in suspected eases, and all were epidermoid carcinoma histopathologically. Curative resection of this condition was made in neither of the cases, and their prognoses were more grave than other esophageal malignancies in our experience. The development of esophageal carcinoma at the site of corrosive esophagitis with resulting benign stricture has now been suspected as a cause and effect relationship between these two conditions, and Kiviranta: stated that the incidence of esophageal cancer in patients with lye stricture of longer duration is a thousand times higher than normal population. During last one decade the authors experienced 5 cases of esophageal carcinoma developed at the site of lye stricture of the esophagus among about 350 cases of lye burned esophagus at the Department of Thoracic & Cardiovascular Surgery, the National Medical Center in Seoul, Korea. In Korea they still use lye as a detergent in rural area, and there are still many persons ingesting lye for suicidal attempt or on accident. Lye stricture of the esophagus is, therefore, the most common esophageal disease needing surgical procedures, and the authors believe that there will be much more eases of lye stricture complicated by esophageal eareinoma repoted in near future in this Country.

• Journal of Chest Surgery
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• v.31 no.9
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• pp.893-898
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• 1998

Material and Method: Esophageal reconstruction by the hypopharyngointestinal anastomosis was done in 7 patients of corrosive upper esophageal stricture at St. Mary's Hospital from August 1995 to January 1997. Result: There were one male and six female patients ranging from 20 to 63 years of age. The causative agents were acid in 6 patients and alkali in 1 patient. The esophageal reconstruction was made by hypopharyngcolojejunostomy in 4 patients and hypopharyngocologastrostomy in 3 patients. There were no operative mortalities. One patient developed anastomotic stenosis but others were free from dysphagia. All gained 4 kg to 13 kg of body weight during the follow-up period. Conclusion: In this experience right colon and terminal ileum including ileocecal valve was revealed as a good substitute for the esophagus and the esophageal reconstruction by hypopharyngocologastro (jejuno)stomy seems to be a satisfactory method with acceptable morbidity and mortality in corrosive upper esophageal stricture patient.

• Clinical and Experimental Pediatrics
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• v.62 no.10
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• pp.395-399
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• 2019

Background: The esophagus is the most common part of gastrointestinal (GI) tract at the risk of stricture. Benign disorders are the leading causes of narrowing. Caustic ingestion is the most common cause of esophageal stricture in children, especially in developing countries. Clinical responses to the topical application of Mitomycin C in various medical procedures have been reported. Purpose: The study aimed to evaluate the methodology, efficacy, and side effects of Mitomycin C in the treatment of esophageal strictures. Methods: This study included 30 children with resistant esophageal strictures. Upper GI endoscopy was performed up to the area of stricture, esophageal dilatation was done, endoscopy was repeated, and Mitomycin C was applied topically under direct endoscopic vision. The effect of the procedure was followed over a period of 3-5 years. Results: The response to Mitomycin C was excellent (clinically and endoscopically) in 28 patients (93.3%) and good (endoscopically only) in 2 patients (6.7%). No side effects of topical Mitomycin C in children with esophageal strictures were reported in this study. Conclusion: Esophageal dilatation followed by local Mitomycin C application may be a useful strategy for treating resistant esophageal strictures.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.3 no.1
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• pp.1-8
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• 2000

Purpose: This study was undertaken to evaluate the clinical features and complication such as esophageal stricture in children with corrosive esophagitis. Methods: We retrospectively reviewed medical records of 31 children who accidentally ingested corrosive materials and visited to emergency room of Chonnam National University Hospital from Jan. 1992 to Dec. 1999. Twenty-one children were examined by upper gastrointestinal (UGI) endoscopy to evaluate location and severity of caustic injury. Results: 1) Among 31 patients, there were 20 males and 11 females and the ratio of male to female was 2:1. Average age at diagnosis was 2.3 years (12 months to 9.8 years). Twenty-seven (87.1%) patients were accidentally ingested vinegar. 2) Initial presenting symptoms were dysphagia (54.8%), vomiting (48.3%), chemical burn on lips and skin (45.2%), excessive salivation (45.2%), coughing and respiratory grunting (32.3%) and aspiration pneumonia (9.8%). 3) UGI endoscopic examination showed caustic injury in 17 children: grade I in 8, grade II in 7 and grade III in 2. The region of caustic injury was proximal esophagus in 5, distal esophagus in 3, entire esophagus in 9 and stomach in 6. 4) Corrosive esophageal strictures developed in 6 children (19.4%) and gastric outlet stricture in 1 (3.2%). All of them showed grade II or III caustic injury on endoscopic examination. Conclusion: The development of esophageal stricture was related to the severity of the caustic injury. Early UGI endoscopic examination in caustic ingestion seems to be useful for prediction of development of caustic stricture.

• Journal of Chest Surgery
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• v.16 no.4
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• pp.584-593
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• 1983

Esophageal reconstruction was performed in 344 patients with irreversible stricture of the esophagus resulting from caustic burns at National Medical Center from 1959 to 1982.There were 113 males and 231 females, and ranging from 2.5 to 58 years of age, and mean age was 26.5 years, and 25 cases were less than 10 years old. Caustic materials were 286 [83.2%] alkali and 50[14.5%] acid. The most frequent stricture site was upper thoracic esophagus as 56.7%, and the next was cervical as 31.4%, and lower, 11.9%. The stomach was involved in 10.8% totally, and hypopharyngeal stricture was also noticed in 3.2%, and in 3 cases, hypopharyngeal reconstruction was needed due to extensive scar change. In 329 of total 344 cases, colon interposition was performed without resection of the strictured esophagus except 4 cases which were complicated T-E fistula or perforation, and most of them, about 10-15 cm of terminal ileum with right half of the colon was used as the graft. The left colon with anti-peristalsis was used as graft only in 30 cases. The most common postoperative complication was anastomotic leak as 16.7% of total cases, and it was 12.5% from neck, 3.3% from ileocolostoma and 0.9% from cologastrostoma. Next common complication was neck stenosis [8.8%], aspiration pneumonia [6.4%], and graft necrosis [3.9%] in order. Overall operative mortality was 5.5% [14/329], and main causes of death were graft necrosis, sepsis due to anastomotic leak, gastric bleeding, and intestinal obstruction. Besides of colon interposition, according to shape or level of the stricture, plastic repair or segmental resection and direct anastomosis was done in 9, and 1 of them were complicated stenosis at the anastomotic site. In lower stricture, esophagogastrostomy was done in 10 cases, and 1 case expired due to hepatitis, and anastomotic stenosis was occurred in 2 cases at 1.5 months and 2.4 years later. During follow-up of 298 cases colon interposition from 6 months to 22 years, 82.6% was excellent, and 2.9% was complained of mild discomfort, and 4 cases were dead laterly, but 3 of them were not related to reconstruction.

• Journal of Chest Surgery
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• v.37 no.7
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• pp.617-621
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• 2004

End-to-end anastomosis for benign esophageal stricture (BES) is technically easier and relatively lower in morbidity than esophago-enterostomy. We performed segmental resection and end-to-end anastomosis in 2 cases of short segmental BES who were failed repeated endoscopic dilatation. A 13-month-old female with postoperative stricture was treated successfully. However, a 27-year-old female with corrosive stricture required second operative management of esophago-colo-gastrostomy following end-to-end anastomosis. Our experiences suggested that end-to-end anastomosis for BES could be used as a valid procedure for well selected patients. However, further studty is needed to compare with esophago-enterostomy.

• Journal of Chest Surgery
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• v.24 no.9
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• pp.895-902
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• 1991

The surgical experience on 18 patients with benign or malignant stricture of the esophagus who underwent isoperistaltic interposition of left colon from April 1989 to July 1991 was reviewed. During same period 22 esophageal reconstructions with colon were performed, but 3 patients who had intraabdominal adhesion in the left upper quadrant and one patient who had uncertainty of blood supply of left colic artery could not undergo iso-peristaltic interposition of left colon. There were 12 male and 6 female patients ranging from 16 to 65 years of age. 12 patients had corrosive esophageal stricture, two had cancer of esophagus, and another two had hypopharyngeal cancer. The postoperative complications developed in 7 patients [38.8%] and most frequently encountered complication was cervical anastomotic leakage, which was successfully managed with simple drainage in all cases but one malignant patient. There was no operative mortality. The esophageal reconstruction with isoperistaltic left colon resulted in good function in 14 patients[77.8%], fair in 3 patients[16.7], and poor in 1 patient[5.6%]. In this experience esophageal reconstruction using isoperistaltic left colon is a satisfactory method that can be accomplished with acceptable morbidity and mortality.

• Journal of Chest Surgery
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• v.34 no.2
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• pp.194-197
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• 2001

부식성 물질에 의한 양성 식도 협착 환자에서 식도 확장술이 일반적으로 사용되는 술식이나 협착부위가 잔존하여 연하곤란이 발생하므로 식도 재건술이 이용된다. 식도재건술은 대용 식도로 위관, 대장관, 소장관이 이용하여 광범위한 박리, 여러 부위의 절개, 문합부 대용 식도 위치에 따른 문제점 및 협착된 식도를 잔존시킴으로 식도암 발생가능성이 있으며 식도 재건술후 식도 기능의 문제점이 많다. 이에 시고 기능에 이상을 초래하지 않으면서 합병증이 적고 수술하기 쉬운 방법이 요구된다. 저자는 식도 근층만을 절개하고 점막하층을 박리한 후 협착부 점막만 절제하고 점막 단단 문합함으로 좋은 결과를 얻었기에 증례와 더불어 수술 방법을 소개하고자 한다.

• Korean Journal of Bronchoesophagology
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• v.5 no.1
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• pp.30-35
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• 1999

Between 1994 to 1998, 7 patients had taken emergency operations by iatrogenic esophageal perforation. To evaluate patterns of injury, clinical presentation, and treatment options for patients, we reviewed all the 7 patients who had gotten transmural injury to the esophagus during dilatations or stenting procedures at our hospital. The primary diagnosis of the patients were as followings , two were achalagia and remaining five were corrosive esophageal strictures. Chest pain, fever, tachycardia were the early signs after esophageal perforation. The sites of perforation were thoracic esophagus in all cases and all of them underwent operation within 8 hours of initial injury. There were no postoperative mortality. Complications were developed three cases： stricture of anastomotic site, mediastinitis due to graft failure of colon and pleural empyema.

• Clinical and Experimental Pediatrics
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• v.52 no.4
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• pp.446-452
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• 2009

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.