A Prospective Study of Management of 100 Cases of Post Acid Ingestion Oesophageal Stricture with Dilatation
Journal Title: New Indian Journal of Surgery - Year 2018, Vol 9, Issue 3
Abstract
Context: study of management of post acid ingestion oesophageal stricture by dilatation. Aims: By studying 100 cases of post acid ingestion stricture to decide effectiveness of dilatation as a alternative of treatment as for transposition or replacement. Settings and Design: This prospective clinical study was carried out on patient of 100 cases diagnose as a Oesophageal stricture due to corrosive ingestion. Methods and Material: This prospective clinical study was carried out on patient of 100 cases diagnose as a Oesophageal stricture due to corrosive ingestion who are b/w 2 to 70 years, having Post acid ingestion oesophageal stricture patient require surgical (intervention) will be included &who haven’t pre-existence oesophageal problems(stricture, Ca, motility disorders etc.), not having congenital TE anomalies, altered renal function & other comorbidities including (DM, HTN & other medical comorbidities). Result: out of 100 cases of post acid ingestion Grade II b injuries were present in 32% (most common) of patients. 85 patients were treated with oesophageal dilatation. Statistical analysis used: Efficacy of conventional measure & criteria & outcome compared with criteria & results of present study to correlate with outcomes percentage of outcome of study were used & were considered success when outcome percentage were better. Data entry and analysis: Data entry and analysis was done in Microsoft excel and frequency distribution and proportion were calculated for variable in the study. Results: Out of 100 patients of post acid ingestion oesophagus with grad IIb and selected grade III treated with dilatation with guide wire and bougie dilator most of patients required repeated dilatation of average 4 dilatation at an interval of 1month with complication of haemorrhage in 10% and hypoxia intra-op in 6% of patients and morbidity of oesophageal perforation in only one patient with null mortality noted. Discussion: Out of 100 patients of post acid ingestion oesophagus with grad IIb [4] and selected grade III treated with dilatation with guide wire and bougie dilator most of patients required repeated dilatation of average 6 dilatation at an different interval depending upon severity an length of injury to oesophagus by acid, with complication of haemorrhage in as many 10% of patients which was mild and managed with withholding procedure and NG tube insertion, other most common complication was hypoxia due to associated laryngeal injury which is most common associated morbidity also with 32% patients having laryngeal injury, with 1% morbidity due to rupture oesophagus and required urgent surgery, ICD insertion. Which later treated with colonic transposition with no mortality were documented with this study. Flexible fibre optic endoscopy made the assessment of upper gastrointestinal injuries accurate, safe, and reliable & practicable. Injury were graded according to modified Zargar et al classification [11], Dilatation is possible (usually 1 to 2 months ) after injury, and were done with guide wire and bougie dilator set after minimum period of 6 weeks as per criteria for intervention in post acid ingestion injury. The endoscope and over the wire dilatation technique for Oesophageal dilatation is most common, Less invasive, preferred 1st line management for less severe injury up to grade IIB and selected grade III although repeated dilatations are required in almost all patients to prevent recurrence at different intervals depending upon, concentration, amount, complaints, severity, availability of sources. Oesophageal dilation is the most common Modality, on-invasive, preferred, first line of management when possible up to grade 3 injury in selected patients Certainly good nutrition and careful peri-operation treatment are important for the healing process. Conclusions: Dilatation relatively safe, acceptable, easy, noncomplex procedure for treatment of post acid ingestion oesophageal stricture management for grade II and selected grade III patients with acceptable complications and no mortality.
Authors and Affiliations
Samir M. Shah
Keywords
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- EP ID EP546006
- DOI 10.21088/nijs.0976.4747.9318.16
- Views 90
- Downloads 0
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