Acquired esophageal stricture following caustic ingestion in children is the most common cause for oesophageal stricture in children. Compared to adults, children are more likely to ingest caustic substances either accidentally or out of curiosity.
Upper GI endoscopy is considered important in the diagnosis, prognostication, and guide to management of caustic ingestions.
A contrast swallow or CT esophagogram may delineate the site and extent of stricture.
Stricture dilatation is the primary method of treatment, but patients with strictures who don’t respond to dilatation require esophageal replacement. Failure of esophageal dilatation may be related to the severity of luminal narrowing or stricture length. Esophageal replacement with reinstitution of oral feeding has been shown to be advantageous in children. The potential for malignant transformation in the retained native esophagus has been reported following caustic injury.
Surgical options include partial or total esophagectomy with gastric pull up, gastric tube or colonic interposition. The video demonstrates a thoracoscopic esophagectomy followed by laparotomy and gastric pull up.