CLINICAL EFFECTIVENESS OF TRADITIONAL TREATMENT METHODS FOR GRADE III CHEMICAL ESOPHAGEAL BURNS IN CHILDREN.

Abstract

Introduction: Chemical esophageal burns in children, especially grade III injuries, frequently lead to cicatricial strictures, persistent dysphagia, and prolonged hospitalization, creating a high risk of complications and disability. Traditional dilation methods (blind bougienage and gastrostomy with string-guided bougienage) remain widely used; however, they are associated with limited effectiveness and a risk of perforation. This study aimed to evaluate real-world outcomes of these traditional approaches and to define their main clinical limitations.

Materials and methods: A retrospective analysis was performed in 115 children (aged 1-14 years) with chemical esophageal burns treated in a hospital setting. Grade III esophageal burns with subsequent cicatricial stricture formation were diagnosed in 46 patients. The severity of stenosis was assessed using the Yu.I. Gallinger classification. Treatment selection was determined by the severity of deformity: direct bougienage was performed when luminal passage was possible, while gastrostomy with string-guided bougienage was used in cases of severe stenosis, inability to safely pass a bougie, or after ineffective blind bougienage. Final clinical outcomes were assessed during hospitalization (at discharge). Because treatment selection depended on stenosis severity and technical feasibility, between-method comparisons were interpreted descriptively in view of confounding by indication.

Results: All patients with grade III burns had cicatricial stenoses of grades II-IV: grade II - 45.6%, grade III - 43.5%, and grade IV - 10.9%. Direct bougienage was feasible as the primary method in 45.7% of cases, whereas gastrostomy with string-guided bougienage was used in 54.3%; this distribution should be interpreted with caution because gastrostomy was preferentially selected for more severe deformity or after failed blind bougienage. Esophageal perforation was recorded in 6.9% of patients. In alkali burns, a 1.6-fold higher need for gastrostomy was observed than in acid burns (73.3% vs 45.2%), but the difference did not reach statistical significance (p=0.115). The mean length of hospital stay was 41.1±2.9 bed-days. Final in-hospital clinical outcomes were: good - 67.4%, satisfactory - 19.6%, and unsatisfactory - 13.0%.

Conclusion: Traditional treatment methods for grade III chemical esophageal burns in children demonstrate important clinical limitations, including a risk of perforation and a frequent need for gastrostomy in severe cases. Given the retrospective design, selection by indication, and the absence of a direct comparison with visually controlled techniques, further comparative studies are needed to determine whether safer dilation under visual or guidewire control improves outcomes.