ORIGINAL ARTICLE Minimally invasive management of children with caustic ingestion: less pain for patients Unal Bicakci • Burak Tander • Gulay Deveci • Riza Rizalar • Ender Ariturk • Ferit Bernay Accepted: 26 October 2009 / Published online: 21 November 2009 Ó Springer-Verlag 2009 Abstract Purpose Management of caustic ingestion in children is still controversial. In this study, we evaluate a minimally invasive management consisting of flexible endoscopy, balloon dilatation and intralesional steroid injection in children, with a history of caustic ingestion. Methods Between April 2002 and January 2009, 350 (206 males and 144 females) children with a history of caustic ingestion were admitted. Enteral feeding was discontinued for 24 h. Parenteral feeding was started in patients with inadequate oral intake. No patient underwent an early esophagoscopy or gastrostomy. A contrast study of upper gastrointestinal tract was performed in all patients with persistent dysphagia within 3 weeks after injury. In case of an esophageal stricture, a dilatation program was initiated. For this purpose, a flexible esophagoscopy was performed. A guidewire was placed through the narrowed segment into the stomach and a balloon dilatator was inserted with the assistance of the guidewire. Balloon dilatations were per- formed every 1–3 weeks. In intractable strictures, triam- cinolone acetonide (TAC) was injected into the narrowed segment via flexible endoscopy. Results Seventeen patients (8 males, 9 females, median 3 years old) required esophageal dilatation. All of the patients completed dilatation program with complete relief of symptoms. None of the patients required any stent application nor esophageal replacement or gastrostomy. Ten patients underwent intralesional TAC injection. No patient had an esophageal perforation or any other com- plication related to dilatation. In all patients, the symptoms have been alleviated completely and no further dilatation was necessary after a median of five dilatation sessions (1–19 dilatations). Conclusion Minimally invasive management of caustic ingestion consisting of flexible endoscopy, guidewire- assisted esophageal balloon dilatation and intralesional TAC injection without any gastrostomy or esophageal stent/placement is effective and leads to relief of dysphagia in almost all patients. This method of dilatation is also safe and iatrogenic esophageal perforation is very unlikely. Keywords Esophageal stricture Á Esophageal dilatation Á Intralesional corticosteroid injection Á Triamcinolone Introduction Esophageal stricture after caustic ingestion remains to be a common problem in children in developing countries [1, 2]. Esophageal strictures develop in 7–15% of patients with caustic ingestion. Different treatment modalities are attempted to prevent stricture formation, such as antibi- otic, corticosteroid, total parenteral nutrition (TPN), nasogastric tube and antiacid [3, 4], but the optimal management remains to be controversial and none of them was found to be effective enough. Esophageal dilatation with esophagoscopy is the traditional treatment for focal esophageal stricture. However, the success rate, and the duration and type of esophageal dilatation remain unclear [5, 6]. In this study, we report a minimally invasive management of children with caustic ingestion and anal- ysis of the outcome. U. Bicakci Á B. Tander (&) Á G. Deveci Á R. Rizalar Á E. Ariturk Á F. Bernay Ondokuz Mayis University, Samsun, Turkey e-mail: btander@omu.edu.tr 123 Pediatr Surg Int (2010) 26:251–255 DOI 10.1007/s00383-009-2525-5