الفهرس 
HistologyOnly 14 pages are availabe for public view
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Abstract
Abstract
Background: Caustic ingestion is still a difficult medical problem, and the outcome is often unexpected. Caustic esophageal strictures are mainly managed by serial esophageal intra-luminal dilation. However, when applied in isolation; it may not reach the necessary diameter for significant symptoms improvement so there is an unmet need to evaluate novel treatments, such as topical mitomycin C (MMC).
Aim of the Work: The main aim of this study was to assess the prognostic factors for success of topical mitomycin C application with endoscopic dilatation on caustic esophageal strictures.
Methods: This prospective study was conducted on patients with post corrosive esophageal stricture (PCOS) with recent history of corrosive ingestion attending to Pediatric Surgery Departments in Ain Shams University and Minia University Pediatric Hospitals in the period between January 2019 and December 2020. Endoscopic dilatation followed by Mitomycin C application was done in all patients. Prognostic factors as age, gender, type of the caustic substance, dysphagia score, site of stricture, length of stricture, need for gastrostomy, need for admission in the intensive care unit (ICU) in the acute stage, laboratory data abnormalities in the acute stage (complete blood picture and arterial blood gases), number of dilatations needed and the required numbers of dilatations per month (periodic dilatation index) were studied in all patients. The patients were followed up for at least 1 and half years after the start of dilatation.
Results: During the specified time period, 24 patients presented to Pediatric Surgery Departments in Ain Shams University and Minia University Pediatric Hospitals. The patient ages ranged from 2 to 10 years. They were 14 (58.3%) males and10 (41.7%) females. In 66.7 % of cases, the caustic agent was alkaline while it was acidic in 33.3% of cases. The mean dysphagia score improved from 3.54± 0.5 to 0.79± 0.66. The site of stricture was at the middle esophagus in 20 (83.3%) cases while 4 (16.7%) cases had stricture in the lower esophagus. The length of stricture was ≥3 cm in 58.3% of cases while 41.7 % of cases had length< 3 cm. Two patients (8.3%) needed gastrostomy. 17 (70.8%) children were admitted at ICU toxicology at acute stage while7 (29.2%) children were not.
The mean hemoglobin level was 10.27 g/dl, the mean total leucocytic count was 11.78 cell/mm3, the mean platelets count was 353,235.29 cell/mm3, the mean pH was 7.464 and the mean PCO2 was 35.0 mmHg. The mean number of dilatations was 12.63± 3.12 and ranged from 7 to 19 and the periodic dilatation index (PDI) The mean PDI in the studied cases was 0.64± 0.14 and ranged from 0.4 to 1.0. Overall, we found that 21 (87.5%) cases showed clinical improvement while 3 (12.5%) cases did not improve. There was significant correlation between the PDI and the success of mitomycin C application with endoscopic dilatation while there is no significant correlation between success and other prognostic factors.
Conclusion: Low periodic dilatation index (PDI) is a good prognostic factor for success of topical mitomycin C application with endoscopic dilatation on caustic esophageal stricture.