Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt.
Department of Pathology, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt.
World J Gastroenterol. 2019 Feb 21;25(7):870-879. doi: 10.3748/wjg.v25.i7.870.
The caustic ingestion continues to be a major problem worldwide especially in developing countries. The long-term complications include stricture and increased life time risk of oesophageal carcinoma. Patients suffered from corrosive induced oesophageal strictures have more than a 1000-fold risk of developing carcinoma of the oesophagus.
To determine the possibility of oesophageal mucosal dysplasia after prolonged dilatation in post corrosive stricture.
This observational study was conducted at the Paediatric Endoscopy Unit in Cairo University Children's Hospital. It included children of both sexes older than 2 years of age who had an established diagnosis of post-corrosive oesophageal stricture and repeated endoscopic dilatation sessions for more than 6 mo. All patients were biopsied at the stricture site after 6 mo of endoscopic dilatation. A histopathological examination of an oesophageal mucosal biopsy was performed for the detection of chronic oesophagitis, inflammatory cellular infiltration and dysplasia.
The mean age of the enrolled children was 5.9 ± 2.6 years; 90% of the patients had ingested an alkaline corrosive substance (potash). The total number of endoscopic dilatation sessions were ranging from 16 to 100 with mean number of sessions was 37.2 ± 14.9. Histopathological examination of the specimens showed that 85% of patients had evidence of chronic oesophagitis (group A) in the form of basal cell hyperplasia, hyperkeratosis and subepithelial fibrosis. Thirteen percent of the patients had evidence of reactive atypia (group B) in the form of severe neutrophilic intraepithelial inflammatory cellular infiltration, and 2 patients (2%) had mild squamous dysplasia (group C); we rebiopsied these two patients 6 mo after the initial pathological assessment, guided by chromoendoscopy by Lugol's iodine.
The histopathology of oesophageal mucosal biopsies in post-corrosive patients demonstrates evidence of chronic oesophagitis, intraepithelial inflammatory cellular infiltration and dysplasia. Dysplasia is one of the complications of post-corrosive oesophageal stricture.
腐蚀性摄入物仍然是一个全球性的主要问题，尤其是在发展中国家。长期并发症包括狭窄和食管癌发生的终生风险增加。患有腐蚀性诱导性食管狭窄的患者患食管癌的风险超过 1000 倍。
确定腐蚀性狭窄后长期扩张后食管黏膜异型增生的可能性。
本观察性研究在开罗大学儿童医院儿科内镜科进行。它包括年龄在 2 岁以上、已确诊为腐蚀性食管狭窄且接受多次内镜扩张治疗超过 6 个月的男女儿童。所有患者在 6 个月的内镜扩张后均在狭窄部位进行活检。对食管黏膜活检进行组织病理学检查，以检测慢性食管炎、炎症细胞浸润和异型增生。
纳入儿童的平均年龄为 5.9 ± 2.6 岁；90%的患者摄入了碱性腐蚀性物质（钾）。内镜扩张次数从 16 次到 100 次不等，平均次数为 37.2 ± 14.9 次。标本的组织病理学检查显示，85%的患者有慢性食管炎的证据（A 组），表现为基底细胞增生、角化过度和上皮下纤维化。13%的患者有反应性异型增生的证据（B 组），表现为严重的中性粒细胞上皮内炎症细胞浸润，2 名患者（2%）有轻度鳞状异型增生（C 组）；我们在最初的病理评估后 6 个月，根据卢戈氏碘染色的 chromoendoscopy 对这两名患者进行了再次活检。
腐蚀性患者的食管黏膜活检组织病理学显示有慢性食管炎、上皮内炎症细胞浸润和异型增生的证据。异型增生是腐蚀性食管狭窄的并发症之一。
