ORIGINAL ARTICLE J. Broto á M. Asensio á C. Soler Jorro á C. Marhuenda J. M. Gil Vernet á D. Acosta á J. Boix Ochoa Conservative treatment of caustic esophageal injuries in children: 20 years of experience Accepted: 5 January 1999 Abstract The authors present their experience in the medical treatment of 1,296 caustic esophageal injuries in children over the last 20 years in two study groups, one comprising the period up to 1989 and the other 1990 to 1996, comparing the dierent treatments used in each group. The treatment was based fundamentally on di- latations with anterograde mercury bougies, Savary bougies, or retrograde thread-guided bougies with gas- trostomy. Pneumatic balloons or stenting procedures have also been employed in the last 3 years. Early ®b- erendoscopy was used systematically in the second group, which provides a more accurate evaluation of the esophageal lesions. Antibiotic coverage was done sys- tematically during the ®rst 10 days in all serious cases, while steroids were employed routinely only in the last 3 years. The results were similar in both groups, with a dilatation average of 32 in the ®rst and 30 in the second group and an initial dilatation interval of 3 to 4 weeks in both. Using updated exploration and dilatation tech- niques, we drastically reduced the number of gastro- stomies needed for retrograde thread-guided dilatations from 51 in the ®rst group to 5 in the second, conse- quently improving the patients' life quality. There was no mortality and only ®ve esophageal perforations, which did not require surgical treatment. Key words Caustic esophageal stenosis á Caustic ingestion á Dilatation procedures Introduction Caustic ingestions are the most common cause of severe esophageal stenosis in children. Although the incidence has decreased in industrialized countries due to security measures imposed on dangerous products, the potential threat to children is in fact greater than ever because of the constantly expanding cleaning-material market. Gel products for dishwashers and drain cleaners, with their attractive appearance, packaging, and odor, are partic- ularly dangerous when swallowed and can produce serious and permanent damage [1, 2]. Dierent techniques are proposed in the treatment of caustic scars, including complete substitution of the esophagus by colon or stomach [3]. Conservative treat- ment is a good solution, and we have used it over the last 20 years with excellent results [4]. The aim of this study was to present our current knowledge on the treatment of these cases, comparing it with our previous experi- ence. Materials and methods In a retrospective clinical study of 1,296 caustic accidents admitted to our hospital in the last 20 years, two study groups were made: one up to 1989 and the other from 1990 to 1996. The principal dierences between both groups were the introduction in the sec- ond of ®beroptic esophagoscopy as an initial study, and the pre- ferred use of Savary bougies, which provide safer and more accurate dilatation [4]. The standard treatment began by inserting a nasogastric (NG) tube into the stomach and administering antibiotic prophylaxis in all symptomatic cases. In cases of stenosis, anterograde dilatations with mercury bougies under general anesthesia were done. If this was not possible, a gastrostomy was performed to allow retrograde thread-guided dilatation [2]. Since 1990, ®berendoscopy has been routinely used in the ex- ploration of these cases. This allows evaluation of the levels of esophageal damage with a view to prognosis. Pneumatic balloons (Fig. 1) or guided Savary bougies are used if the esophageal lumen allows. In the last 2 years stenting procedures were employed in 6 cases. Results Of the 1,296 admitted cases, 57% were boys and 43% girls. The average age was 3.3 years (range 1.5 to 10 Pediatr Surg Int (1999) 15: 323±325 Ó Springer-Verlag 1999 J. Broto (&) á M. Asensio á C. Soler Jorro á C. Marhuenda J.M. Gil Vernet á D. Acosta á J. Boix Ochoa Department of Pediatric Surgery, Hospital Materno-infantil Valle de HebroÂn, E-08035 Barcelona, Spain