Öz
Amaç: Çalışmamızda endoskopi gerektiren özofagus bozukluğu olan çocuk hastaların demografik özelliklerini, bu hastalarda rijid ve bükülebilir endoskopi endikasyonlarını, işlem komplikasyonlarını ve sonuçlarını değerlendirdik.
Gereç ve Yöntemler: Ocak 2005 - Şubat 2020 tarihleri arasında endoskopi planlanan çocukların kayıtları incelendi. Klinik veriler, endoskopi yöntemleri, sonuç ve komplikasyonlar araştırıldı. Bükülebilir endoskopi (BE) ve rijid endoskopi (RE) grupları karşılaştırıldı.
Bulgular: Toplam 242 olgu saptandı. Yetmişi yabancı cisim yutma (%28.9), 89’u kostik madde içme (%36.8), 52’si özofagus darlığı (%21.5) ve 31’i diğer nadir durum (%12.8) olgularıydı. Kırk iki hastaya, onam verilmediği için endoskopi yapılmadı. Ortalama yaş 36.4±35.7 aydı. Olguların 102’sine (%42.1) RE, 98’ine (%40.5) BE uygulandı. İki grubun ortalama arasında istatistiksel olarak anlamlı fark yoktu (33.3±32.1 ve 33.7±24.9 ay, p=0.918). BE yapılan hastaların çoğunlukla erkek olduğu (BE grubunda %2, RE grubunda %39.2, p=0.046). RE grubunda komplikasyon oranı %6.9’di ve BE grubunda ise komplikasyon yoktu (p=0.008). Gruplar arasında başarısızlık oranı açısından anlamlı bir fark yoktu (RE’de %3.9 ve BE’de 0, p=0.066).
Sonuç: Hem rijid hem de bükülebilir endoskopi teknikleri, özofagus hastalıklarında tanısal veya terapötik olarak etkili ve güvenli olarak kullanabilir. Her birine özgü avantaj ve kısıtlılıklarla birlikte, rijid endoskopinin komplikasyon riski daha yüksektir.
Kaynakça
- 1. Gmeiner D, von Rahden BH, Meco C, Hutter J, Oberascher G, Stein HJ. Flexible versus rigid endoscopy for treatment of foreign body impaction in the esophagus. Surg Endosc 2007;21(11):2026–2029. doi:10.1007/s00464-007-9252-6
- 2. Popel J, El-Hakim H, El-Matary W. Esophageal foreign body extraction in children: flexible versus rigid endoscopy. Surg Endosc 2011;25(3):919–922. doi:10.1007/s00464-010-1299-0
- 3. Hoffman RS, Burns MM, Gosselin S. Ingestion of Caustic Substances. N Engl J Med. 2020 Apr 30;382(18):1739-1748. doi: 10.1056/NEJMra1810769
- 4. Fallahi S, Hosseini SMV, Fallahi S, Salimi M, Hesam AA, Hoseini SH. Extent of injury of gastrointestinal tract due to accidental ingestion of chemicals among children at Bandar Abbass Children Hospital 2009-2011. Life Sci J. 2012;9(4):2054-2058.
- 5. Temiz A, Oguzkurt P, Ezer SS, Ince E, Hicsonmez A. Long-term management of corrosive esophageal stricture with balloon dilation in children. Surg Endosc Other Interv Tech. 2010;24(9): 2287-2292. doi:10.1007/s00464-010-0953-x.
- 6. Bicakci U, Tander B, Deveci G, et al. Minimally invasive management of children with caustic ingestion: less pain for patients. Pediatr Surg Int. 2010; 26 (3): 251-255
- 7. Niedzielski A, Schwartz SG, Partycka-Pietrzyk K, Mielnik-Niedzielska G. Caustic Agents Ingestion in Children: A 51-Year Retrospective Cohort Study Ear Nose Throat J. 2020 Jan;99(1):52-57. doi: 10.1177/0145561319843109.
- 8. Barrón Balderas A, Robledo Aceves M, Coello Ramírez P, García Rodríguez E, Barriga Marín JA. Endoscopic findings of the digestive tract secondary to caustic ingestion in children seen at the Emergency Department. Arch Argent Pediatr. 2018 Dec 1;116(6):409-414. doi: 10.5546/aap.2018.eng.409.
- 9. Kramer RE, Lerner DG, Lin T, Manfredi M, Shah M, Stephen TC et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN endoscopy committee. J Pediatr Gastroenterol Nutr 2015;60(4):562–74.
- 10. Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF,et al. Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002; 55(7):802–806
- 11. Russell RT, Cohen M, Billmire DF. Tracheoesophageal fistula following button battery ingestion: successful non-operative management. J Pediatr Surg 2013; 48(2):441–444. doi:10.1016/j. jpedsurg.2012.11.040
- 12. Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging battery-ingestion hazard: clinical implications. Pediatrics 2010;125(6):1168–1177 doi:10.1542/peds.2009-3037
- 13. Tiryaki T, Akbıyık F, Şenel E, Mambet E, Livanelioğu Z, Atayurt H. Foreign Body Ingestion in Childhood. Turkish J. Pediatr. Dis. 2010; 4 (2): 94-99
- 14. Russell R, Lucas A, Johnson J, Yannam G, Griffin R, Beierle E,etr al. Extraction of esophageal foreign bodies in children: rigid versus flexible endoscopy Pediatr Surg Int 2014;30:417–422 doi:10.1007/s00383-014-3481-2
- 15. Sink JR, Kitsko DJ, Mehta DK, Georg MW, Simons JP. Diagnosis of Pediatric Foreign Body Ingestion: Clinical Presentation, Physical Examination, and Radiologic Findings. Ann Otol Rhinol Laryngol. 2016 Apr;125(4):342-50. doi: 10.1177/0003489415611128
- 16. Yan XE, Zhou LY, Lin SR, Wang Y, Wang YC. Therapeutic Effect of Esophageal Foreign Body Extraction Management: Flexible versus Rigid Endoscopy in 216 Adults of Beijing. Med Sci Monit. 2014 Oct 27;20:2054-60. doi: 10.12659/MSM.889758.
- 17. Ferrari D, Aiolfi A, Bonitta G, Riva CG, Rausa E, Siboni S, et al. Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and metaanalysis. World J Emerg Surg. 2018 Sep 12;13:42. doi: 10.1186/s13017-018-0203-4. eCollection 2018
- 18. ASGE Standards of Practice Committee, Ikenberry SO, Jue TL, Anderson MA, Appalaneni V, Banerjee S, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc 2011;73:1085-91 doi: 10.1016/j.gie.2010.11.010.
- 19. Wennervaldt K, Melchiors J. Risk of perforation using rigid oesophagoscopy in the distal part of oesophagus. Dan Med J. 2012; 59 (11): A4528
- 20. Gu Z, Wang Y, Lin K, Wang X, Cheng W, Wang L, et al.Magnetically Controlled Capsule Endoscopy in Children: A Single-center, Retrospective Cohort Study J Pediatr Gastroenterol Nutr. 2019 Jul;69(1):13-17. doi: 10.1097/MPG.0000000000002292.
Öz
Objective: We aimed to focus descriptively and comparatively on the children with esophageal disorders requiring endoscopy: demographics, indications, methods, complications and outcomes.
Material and Methods: The records of the children with esophageal disorders indicative of endoscopy between January 2005 and February 2020 at the department of pediatric surgery of a tertiary health care center were reviewed in terms of demographic, etiological, technical aspects; including the comparison of flexible endoscopy (FE) and rigid endoscopy (RE).
Results: Endoscopy was indicated in a total of 242 children for foreign body ingestion (n=70, 28.9%), caustic ingestion (n=89, 36.8%), esophageal stricture (n=52, 21.5%) and other rare conditions (n=31, 12.8%). Fourty two of them did not undergo endoscopy, because their caregivers did not consent. Of the rest; 102 (42.1%) underwent RE, and 98 (40.5%) underwent FE. The mean age was 36.4±35.7 months. No statistically significant difference was detected between the mean ages of RE and FE groups (33.3±32.1 vs. 33.7±24.9 months, p=0.918). Most of the patients who underwent FE were significantly males (52% in FE group, 39.2% in RE group, p=0.046). Complication rate was 6.9% in RE group and no complication was detected in FE group (p=0.008). The difference of failure rates of the groups was statistically insignificant (3.9% in RE vs 0 in FE, p=0.066).
Conclusion: Both rigid and flexible endoscopy techniques are effective and safe for diagnostic or therapeutic esophageal interventions. Although each has its own advantages an disadvantages, performing rigid endoscopy takes a slightly but significantly higher risk of complication.
Kaynakça
- 1. Gmeiner D, von Rahden BH, Meco C, Hutter J, Oberascher G, Stein HJ. Flexible versus rigid endoscopy for treatment of foreign body impaction in the esophagus. Surg Endosc 2007;21(11):2026–2029. doi:10.1007/s00464-007-9252-6
- 2. Popel J, El-Hakim H, El-Matary W. Esophageal foreign body extraction in children: flexible versus rigid endoscopy. Surg Endosc 2011;25(3):919–922. doi:10.1007/s00464-010-1299-0
- 3. Hoffman RS, Burns MM, Gosselin S. Ingestion of Caustic Substances. N Engl J Med. 2020 Apr 30;382(18):1739-1748. doi: 10.1056/NEJMra1810769
- 4. Fallahi S, Hosseini SMV, Fallahi S, Salimi M, Hesam AA, Hoseini SH. Extent of injury of gastrointestinal tract due to accidental ingestion of chemicals among children at Bandar Abbass Children Hospital 2009-2011. Life Sci J. 2012;9(4):2054-2058.
- 5. Temiz A, Oguzkurt P, Ezer SS, Ince E, Hicsonmez A. Long-term management of corrosive esophageal stricture with balloon dilation in children. Surg Endosc Other Interv Tech. 2010;24(9): 2287-2292. doi:10.1007/s00464-010-0953-x.
- 6. Bicakci U, Tander B, Deveci G, et al. Minimally invasive management of children with caustic ingestion: less pain for patients. Pediatr Surg Int. 2010; 26 (3): 251-255
- 7. Niedzielski A, Schwartz SG, Partycka-Pietrzyk K, Mielnik-Niedzielska G. Caustic Agents Ingestion in Children: A 51-Year Retrospective Cohort Study Ear Nose Throat J. 2020 Jan;99(1):52-57. doi: 10.1177/0145561319843109.
- 8. Barrón Balderas A, Robledo Aceves M, Coello Ramírez P, García Rodríguez E, Barriga Marín JA. Endoscopic findings of the digestive tract secondary to caustic ingestion in children seen at the Emergency Department. Arch Argent Pediatr. 2018 Dec 1;116(6):409-414. doi: 10.5546/aap.2018.eng.409.
- 9. Kramer RE, Lerner DG, Lin T, Manfredi M, Shah M, Stephen TC et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN endoscopy committee. J Pediatr Gastroenterol Nutr 2015;60(4):562–74.
- 10. Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF,et al. Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002; 55(7):802–806
- 11. Russell RT, Cohen M, Billmire DF. Tracheoesophageal fistula following button battery ingestion: successful non-operative management. J Pediatr Surg 2013; 48(2):441–444. doi:10.1016/j. jpedsurg.2012.11.040
- 12. Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging battery-ingestion hazard: clinical implications. Pediatrics 2010;125(6):1168–1177 doi:10.1542/peds.2009-3037
- 13. Tiryaki T, Akbıyık F, Şenel E, Mambet E, Livanelioğu Z, Atayurt H. Foreign Body Ingestion in Childhood. Turkish J. Pediatr. Dis. 2010; 4 (2): 94-99
- 14. Russell R, Lucas A, Johnson J, Yannam G, Griffin R, Beierle E,etr al. Extraction of esophageal foreign bodies in children: rigid versus flexible endoscopy Pediatr Surg Int 2014;30:417–422 doi:10.1007/s00383-014-3481-2
- 15. Sink JR, Kitsko DJ, Mehta DK, Georg MW, Simons JP. Diagnosis of Pediatric Foreign Body Ingestion: Clinical Presentation, Physical Examination, and Radiologic Findings. Ann Otol Rhinol Laryngol. 2016 Apr;125(4):342-50. doi: 10.1177/0003489415611128
- 16. Yan XE, Zhou LY, Lin SR, Wang Y, Wang YC. Therapeutic Effect of Esophageal Foreign Body Extraction Management: Flexible versus Rigid Endoscopy in 216 Adults of Beijing. Med Sci Monit. 2014 Oct 27;20:2054-60. doi: 10.12659/MSM.889758.
- 17. Ferrari D, Aiolfi A, Bonitta G, Riva CG, Rausa E, Siboni S, et al. Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and metaanalysis. World J Emerg Surg. 2018 Sep 12;13:42. doi: 10.1186/s13017-018-0203-4. eCollection 2018
- 18. ASGE Standards of Practice Committee, Ikenberry SO, Jue TL, Anderson MA, Appalaneni V, Banerjee S, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc 2011;73:1085-91 doi: 10.1016/j.gie.2010.11.010.
- 19. Wennervaldt K, Melchiors J. Risk of perforation using rigid oesophagoscopy in the distal part of oesophagus. Dan Med J. 2012; 59 (11): A4528
- 20. Gu Z, Wang Y, Lin K, Wang X, Cheng W, Wang L, et al.Magnetically Controlled Capsule Endoscopy in Children: A Single-center, Retrospective Cohort Study J Pediatr Gastroenterol Nutr. 2019 Jul;69(1):13-17. doi: 10.1097/MPG.0000000000002292.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Cerrahi |
| Bölüm | ORIGINAL ARTICLES |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Ocak 2022 |
| Gönderilme Tarihi | 2 Mart 2021 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 16 Sayı: 1 |