ABSTRACT: Objective Due to advances in neonatal care and operative technique, the Waterston's system of prognostic classification for esophageal atresia (EA) is no longer considered useful in the developed world. This study seeks to examine the preoperative factors related to prognosis in babies operated for EA under our conditions. Patients and Method This is a prospective study of 89 consecutive neonates treated for EA/tracheoesophageal fistula (TEF) between Jan 2000 and Dec 2000. No patient was excluded from the study. A detailed record of various factors affecting outcome was maintained. Statistical Analysis The X2 test and Student's test were used for comparative analysis with a significance level of p0.05. Stepwise forward regression analysis was also used, to obtain estimates of the risk of hospital death of infants with EA. Results Overall survival in babies with EA was only 48 percent while survival in patients undergoing primary esophageal anastomosis was 61 percent. The factors significantly affecting survival were pneumonia at presentation, birth weight, gestational age, preoperative sepsis and perinatal asphyxia. Maternal age, gravidity, age at presentation and attempted feeds before presentation did not significantly affect survival. Logistic regression analysis revealed pneumonia and birth weight to be the most important prognostic factors. However, Waterston's classification had significantly better correlation with survival than the above factors alone. Conclusion Waterston's stratification is valid and relevant as a prognostic indicator under our circumstances.

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ABSTRACT: Caustic esophageal burns is a health problem. From January 1990 to July 1999, we attended 149 patients with caustic esophageal burns (85 male, 64 female) :18 patients below 1 year of age, 112 between 1 and 4, 13 between 5 and 10 and 6 over 10. the principal chemical substance was lye (111 cases), followed by muriatic acid (17 cases). We divided the patients in 2 groups : Group I patients with esophagoscopy (127), Group II patients without esophagoscopy (12). The second group did not have endoscopy because they came late and were treated as patient with burn. Results 118 cases had one or more lesions outside the esophagus. In group I, 25 patients had burns type I,51 type II and 6 type III (Zargar's classification), 45 patients did not have lesions by endoscopy. Sixteen had esophageal stenosis treated with esophageal dilatation and 4 had esophageal substitution with colon. In group II, 9 patients had stenosis and 4 had esophageal substitution. There were 31 patients with visible clinical injuries. Endoscopy was performed in 18, 7 had burns type I, 4 had burns type II 2 underwent esophageal replacement with colon. Four of the 10 patients more than 10 years of age had attempted suicide.

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ABSTRACT: Esophageal strictures are a major cause of morbidity and mortality in children. They may develop as a primary constriction, due to chemical injury after corrosive ingestion or following gastroesophageal reflex disease, secondary to a surgically repaired esophageal atresia (with or without tracheoesophageal fistula) or following any esophageal injury. Strictures are also encountered in children following sclerotherapy for portal hypertension. In developing countries easy access to corrosive agents and accidental ingestion by children makes it a leading cause of benign strictures in children. The results of esophageal dilations in 137 children with benign strictures over a 14 year period is detailed in this communication.

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ABSTRACT: The authors report their experience with caustic agent ingestion in children. Between 1999 and 2000 254 patients, 150 boys (59 percent) and 104 girls (41 percent), between 5 months and 13 years presented to the emergency department of our hospital with history suggestive of caustic chemical ingestion. All patients were referred within 6 hours of accidental caustic chemical ingestion. Upper GI endoscopy was performed between 12 and 24 hours of ingestion of caustic agent in 222 children. almost all (97 percent) children recovered well with conservative management. Seven patients (2.8 percent) developed esophageal strictures; of which one required esophageal substitution.

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ABSTRACT: Surgery for gastroesophageal reflux disease in infants and children has been shown to be safe and effective in short term follow up, but no long term follow up is available on children who have had Thal fundoplication. This study assesses the long term structural and functional integrity of the Thal fundoplication carried out in children less than 2 year of age at least 10 years earlier. Subjective assessment of symptoms in all patients and objective tests (barium upper GI series, 24 hour pH study) in 24 randomly selected children were performed. At long term follow-up, 100 percent had correction of symptoms with 96 percent parental satisfaction. Majority could belch (96 percent) and vomit (79 percent). Twenty four-hour pH studies done in the first 12 patients was essentially normal. Hiatus hernia with an intact wrap is a frequent radiological finding in long term follow-up which does not require any treatment in asymptomatic patients.

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ABSTRACT: Esophageal stricture in children may develop as a primary constriction, secondary to a surgically repaired Esophageal Atresia (EA) with or without Tracheo-Esophageal Fistula (TEF(, as a result of chemical injury after caustic ingestion or following esophageal surgery. Between 1995 to 2002, 33 patients underwent oesophageal dilatation for treatment to esophageal strictures at our institution. Their age range was 1 month to 11 yrs. There were 20 males and 13 females. There were 21 patients with stricture following EA with TEF repair, 7 with corrosive stricture, 2 with peptic structure and 3 with congenital esophageal stenosis (type-1). Patients were managed by either axial or radial dilatation on an average of 2 to 4 sessions at an interval of 1 to 2 months. Those who did not respond to this treatment were subjected to surgical correction. We share our experience in the management of stricture esophagus over a of period of 7 years by using axial and radial (balloon) dilators.

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ABSTRACT: Manometric evaluation of esophageal motility and IES function in children with persistent dysphagia following corrosive injury to esophagus have been done in this study. This study includes 18 patients (12 male, 6 female) with a mean age of 4.3 years. All patients were managed by a standard protocol. Esophageal manometry using Albyn Medical System by continuous perfusion of wave technique was done in 18 children. Fourteen patients (77 percent) showed abnormal finding on manometry. The cinefluroscopy done in 7/14 children showed abnormal to and fro movements of bolus suggesting non propagation in 4 patients and mild stricture in 2 patients; 3/4 patients showed improvement in symptoms and manometry findings following cisapride therapy.

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ABSTRACT: We report our experience in treating esophageal strictures with balloon dilatation in 19 patients with esophageal affection in Epidermolysis bullosa (EB) dystrophic type. We performed 84 dilatations, all under general anesthesia. All patients could be sufficiently dilated by balloons and tolerated the procedure well. We did not experience any complications. In spite of the fact that repeated procedures will be necessary according to the progressive nature of the disease, we found this mode superior to operative procedures, stoma or replacement.

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ABSTRACT: The following study was undertaken by the authors at the Beijing Children's Hospital, to assess the efficacy of retrograde dilatation in the treatment of secondary cicatricial esophageal stenosis (CES). Between 1958 and 2000, 348 cases of CES were admitted to the Beijing Children's Hospital. Of the 348 cases, 212 (Corrosive Strictures) were cured by retrograde dilation and 7 (Anastomotic Strictures) by oral bouginage. Among the remaining cases, 47 cases needed operative reconstruction and 82 cases continue to undergo retrograde dilatation till end of 2000. The standard of cure was ability `to take solid food' without difficulty. In the authors' view, retrograde dilatation should be the treatment of choice for corrosive strictures, while oral bouginage is good for anastomotic strictures. Subcutaneous placement of esophagus is better than retrosternal placement in those patients requiring colonic transposition.

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ABSTRACT: The saga of a boy who swallowed corrosive in 1975 when he was 16 months old is described. He had, over a period of 22 years, 52 dilatations, 2 episodes of perforation and 3 major operations to restore normal swallowing. He finally agreed to a permanent gastrostomy in 1998. This operation restored his health and improved the state of his esophagus. It has enabled him to keep away from surgeons over the last 4 years and maintain his nutrition, partly by oral and partly by gastrostomy feeds. It is felt that the place of permanent gastrostomy in the management of severe corrosive stricture of the upper esophagus is greatly underestimated.

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ABSTRACT: A 4-year old boy presented with inability to swallow both solids and liquids 3 weeks following ingestion of corrosive chemical. The whole of the thoracic esophagus had an impassable stricture. A gastric substitution was done to replace the thoracic esophagus. The patient developed a stricture at the cerviogastric anastomosis 1 month after surgery. This was successfully treated by stricturoplasty using buccal mucosal graft.

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ABSTRACT: The author presents his experience with treatment of 241 cases of cicatrising esophageal stenosis. Of these, 172 patients were treated with dilatation and 69 patients were treated with stents. A detailed analysis of the advantages of a novel stent therapy as a continuous dilatation technique covering the entire range of the remodelling period of the cicatrix, has been made in the article. Efficacy of systemic and intra lesional have been compared. Only 11 patients, out of the 241, underwent surgery for strictures not responding to stent/dilation therapy. Extraluminal removal of scarred cicatrix as an alternative to esophageal replacement procedures has been performed in 25 children and the results have been discussed.

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