Abstract
Introduction: This study aimed to evaluate the effects of stent placement prior to stricture development following caustic esophageal burn (CEB) in an animal model. The outcomes after stent placement were also compared with those after balloon dilatation and cutting balloon dilatation performed after stricture development. Groups were compared with regard to stricture development and weight loss.
Materials and Methods: 40 rats were divided into 5 groups. CEB was created as described by Gehanno et al. In Group A (control) no CEB was performed and the esophagus was only rinsed with saline. Group B rats underwent CEB with no subsequent treatment. Group C rats underwent CEB followed by balloon dilatation in the 3rd and 4th week. Group D rats underwent CEB followed by cutting balloon dilatation in the 3rd week. Group E rats underwent CEB with subsequent placement of a silicon stent in the same session. The animals were sacrificed in the 6th week, and the stenosis index (SI), collagen deposition, and hydroxyproline (HP) levels were determined in the esophageal segments and statistically compared.
Results: Although weight loss occurred in Group C and Group B rats (238.87±15.95 g vs. 233.83±19.01 g), weight loss in Group C rats was less marked compared to Group B. Similarly, the SI in Group C was lower compared to that of Group B and the difference was statistically significant. Although there was no difference in weight between the rats in Group C and Group B before the procedure (p=0.318), there was statistically significant difference thereafter (p=0.002). The SI of Group D was also lower compared with that of Group B, and the difference was statistically significant. Weight gain in Group E rats was similar to that noted in Group A rats and was higher compared to Group B; this difference was statistically significant. The SI for Group E was lower compared to that of Group B.
Conclusion: Stenting performed at the time of corrosive injury and cutting balloon dilatation performed after stricture formation had a positive effect with regard to SI and weight gain in an animal model.
Key words
corrosive - esophagus - stent - balloon - cutting balloon
References
-
1
Ramasamy K, Gumaste VV.
Corrosive ingestion in adults.
J Clin Gastroenterol.
2003;
37
(2):
119-124
-
2
Bautista Casasnovas A, Estevez Martinez E, Varela Cives R. et al .
A retrospective analysis of ingestion of caustic substances by children. Ten-year statistics in Galicia.
Eur J Pediatr.
1997;
156
(5):
410-414
-
3
Nuutinen M, Uhari M, Karvali T. et al .
Consequences of caustic ingestions in children.
Acta Paediatr.
1994;
83
(11):
1200-1205
-
4
Gehanno P, Guedon C.
Inhibition of experimental esophageal lye strictures by penicillamine.
Arch Otolaryngol.
1981;
107
145-147
-
5
Demirbilek S, Bernay F, Rizalar R. et al .
Effects of estradiol and progesterone on the synthesis of collagen in corrosive esophageal burns in rats.
J Pediatr Surg.
1994;
29
1425-1428
-
6
Berthet B, di Costanzo J, Arnaud C. et al .
Influence of epidermal growth factor and interferon gamma on healing of oesophageal corrosive burns in the rat.
Br J Surg.
1994;
81
395-398
-
7
Woessner JB.
The determination of hydroxyproline in tissue and protein samples containing small proportions of this amino acid.
Arch Biochem Biophys.
1961;
93
440
-
8
Osman M, Russell J, Shukla D. et al .
Responses of the murine esophageal microcirculation to acute exposure to alkali, acid, or hypochlorite.
Pediatr Surg.
2008;
43
1672-1678
-
9
Mutaf O, Avano–lu A, Mevsim A. et al .
Management of tracheoesophageal fistula as a complication of esophageal dilatations in caustic esophageal burns.
J Pediatr Surg.
1995;
30
(6):
823-826
-
10 Millar AJW, Numanoglu A, Rode H. Caustic strictures of the esophagus.. In: Grosfeld JL, O’Neill Jr JA, Fonkalsrud EW, Coran AG editors. Pediatric Surgery. 6th ed. Philadelphia: Mosby Inc; 2006: 1082-1093
-
11
Zargar SA, Kochhar R, Mehta S. et al .
The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns.
Gastrointest Endosc.
1991;
37
(2):
165-169
-
12
Hollinger PH.
Management of lesions caused by chemical burns.
Ann Otol Rhinol Laryngol.
1968;
77
19
-
13
Di Costanzo J, Noirclerc M, Jouglard J. et al .
New therapeutic approach to corrosive burns of the upper gastrointestinal tract.
Gut.
1980;
21
370-375
-
14
Türkyılmaz Z, Sönmez K, Karabulut R. et al .
Mitomycin C decrease the rate of stricture formation in caustic esophageal burns in rats.
Surgery.
2009;
145
(2):
219-224
-
15
Hamza AF, Abdelhay S, Sherif H. et al .
Caustic esophageal strictures in children: 30 years's experience.
J Pediatr Surg.
2003;
38
(6):
828-833
-
16
Mutaf O.
Treatment of corrosive esophageal strictures by long-term stenting.
J Pediatr Surg.
1996;
31
(5):
681-685
-
17
Gündoıdu HZ, Tanyel FC, Büyükpamukçu N. et al .
Conservative treatment of caustic esophageal strictures in children.
J Pediatr Surg.
1992;
27
(6):
767-770
-
18
Tam PK, Sprigg A, Cudmore RE. et al .
Endoscopy-guided balloon dilatation of esophageal strictures and anastomotic strictures after esophageal replacement in children.
J Pediatr Surg.
1991;
26
(9):
1101-1103
-
19
Doo EY, Shin JH, Kim JH. et al .
Oesophageal strictures caused by the ingestion of corrosive agents: effectiveness of balloon dilatation in children.
Clin Radiol.
2009;
64
265-271
-
20
Temiz A, Oguzkurt P, Ezer SS. et al .
Long-term management of corrosive esophageal stricture with balloon dilatation in children.
Surg Endosc.
2010;
24
2287-2292
-
21
Atabek C, Sürer , Demirba– S. et al .
Increasing tendency in caustic esophageal burns and long-term polytetrafluorethylene stenting in severe cases: 10 years’ experience.
J Pediatr Surg.
2007;
42
636-634
-
22
Broto J, Asensio M, Vernet JM.
Results of a new technique in the treatment of severe esophageal stenosis in children: poliflex stents.
J Pediatr Gastroenterol Nutr.
2003;
37
(2):
203-206
-
23
Wijburg FA, Beukers MM, Heymans HS. et al .
Nasogastric intubation as sole treatment of caustic esophageal lesions.
Ann Otol Rhinol Laryngol.
1985;
94
337-341
-
24 Reyes HM. Caustic stricture of the esophagus.. In: Grosfeld JL editor. Common Problems in Pediatric Surgery. St. Louis: Mosby-Year Book Inc; 1991: 175-183
-
25
Zhou JH, Jiang YG, Wang RW. et al .
Prevention of stricture development after corrosive esophageal burn with a modified esophageal stent in dogs.
J Thorac Cardiovasc Surg.
2008;
136
(5):
1336-1342
-
26
Atar E, Bachar GN, Eitan M. et al .
Peripheral cutting balloon in the management of resistant benign ureteral and biliary strictures: long-term results.
Diagn Interv Radiol.
2007;
13
(1)
39-41
-
27
Tsetis D, Morgan R, Belli AM.
Cutting balloons for treatment of vascular stenoses.
Eur Radiol.
2006;
16
(8):
1673-1683
-
28
Wilkinson AG, MacKinlay GA.
Use of cutting balloon in the dilatation of caustic oesophageal stricture.
Pediatr Radiol.
2004;
34
(5):
414-416
Correspondence
Dr. Ramazan Karabulut
Gazi University Faculty of
Medicine
Department of Pediatric
Surgery
Gezegen Sokak No.: 1/10
06670 GOP Ankara
Turkey
Telefon: +90 312 202 62 10
Fax: +90 312 223 05 28
eMail: karabulutr@yahoo.com
