Managing Oesophageal Caustic Injury in a Resource‑constrained Environment: A National Cohort Study

Introduction: Injury to the oesophagus due to ingestion of caustic substances is a common reason for presentation to paediatric surgical services worldwide. We report the experience of managing these injuries in a resource‑constrained environment. Methods: All patients presenting to specialist paediatric surgical services in The Gambia following ingestion of a caustic substance over 11 months (December 2021–November 2022) were identified and invited for surgical assessment including contrast swallow, endoscopy under general anaesthetic and oesophageal dilatation where indicated. Those who attended formed the study cohort. Data collected included age, time since caustic ingestion, oral intake using the International Dysphagia Diet Standardisation Initiative (IDDSI) dysphagia score, treatment given and outcome. Results: Twenty‑five patients presented in the 11 months, of these, 12 attended for further assessment and formed the study cohort. Of the 13 who did not, one is known to have died (cause unknown) and the remainder is lost to follow‑up. Median age was 4.5 years (range: 2–14 years); duration from injury was 7 months (2–144). The median IDDSI score at the presentation was 4 (0–6). Nine children underwent oesophageal dilatation with a median improvement in IDDSI score of 2 (0–3). Conclusion: Caustic injury of the oesophagus is a common presentation in The Gambia. Accessing specialist surgical care is challenging for patients. Oesophageal dilatation is feasible in most cases and has the potential to significantly improve oral intake. More severe cases not amenable to dilatation pose a significant challenge. A public health approach to try and prevent oesophageal injuries from occurring is needed. Keywords: Caustic, low‑ and middle‑income countries, oesophagus, stricture