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Spyridon Davakis, Efstratia Mpaili, Athanasios Syllaios, Michail Vailas, Hasemaki Natasha, Eleandros Kyros, Ilias Vagios, Theodoros Liakakos, Alexandros Charalabopoulos, P170 CORROSIVE INJURY OF THE UPPER GASTROINTESTINAL TRACT: LAPAROSCOPIC TOTAL GASTRECTOMY AS A LATE REPAIR TREATMENT, Diseases of the Esophagus, Volume 32, Issue Supplement_2, November 2019, doz092.170, https://doi.org/10.1093/dote/doz092.170
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Abstract
Surgical treatment is considered the gold standard for the treatment of severe upper gastrointestinal burns and of late sequels after ingestion of corrosive agents. The extent of esophageal and gastric involvement largely depends on the nature of the corrosive used. Acid affects the stomach more commonly than alkali. When the ingested corrosive volume is large, the entire stomach can become scarred forming a diffusely contracted non-expandable pouch. Endoscopic management of esophageal and gastric strictures as well as early or delayed surgical treatment still remains debatable and challenging.
To review the treatment algorithm of caustic injuries of the upper gastrointestinal tract, early or delayed, the role of endoscopic management, nutritional support and the need for early or delayed surgical intervention. In addition, the role of minimally-invasive procedures is examined.
A 56-year-old, psychiatric female patient was referred to our department 3 months following caustic acid ingestion. She presented with dysphagia and extensive weight loss. Endoscopy revealed severe stenosis of esophago-gastric junction, circumferential and deep ulcerations of the stomach and pyloric stenosis. Esophago-gastric stenosis was treated with multiple endoscopic bougie-dilations. The patient underwent laparoscopic total gastrectomy with Roux-en-Y handsewn esophago-jejunal anastomosis. Post-operative course was uneventful. During a 6-month follow-up period, no signs restenosis have been observed.
The most common presentation of an acute corrosive gastric burn is with abdominal pain, vomiting and hematemesis. The most useful investigation is an upper gastrointestinal endoscopy; endoscopic dilations of esophageal and gastric strictures are utilized. For patients with severe lesions and gastric perforations, early intervention and laparotomy/laparoscopy are performed. For delayed surgical treatment, total gastrectomy or esophagectomy can be performed. Minimally-invasive techniques are safe and can provide excellent results for the management of gastric and esophageal strictures.
