I have a 24 years old female with a long segment od post-corrosive esophageal stricture. She is not taking any thing per mouth. What is the best time to intevene and what to do?
She should be worked up with barium studies and Endoscopy. Depending on how tight the stricture is endoscopic or interventional radiology serial dilatations May start any time from 3-4 weeks but not until all of the acute issues (ITU etc) have been dealt with. An NJT is sometimes helpful as it maintains a lumen (allowing guidewire access if very severe stricturing) plus of course a feeding route. Dilatations need to be quite regular for the first 2-3 attempts eg every two weeks to maintain improvement. Usually dilatations will improve things but your second choice options may be triamcinolone injections or last resort reconstructive surgery. Hopefully the stomach is spared and could be used as a conduit in this scenario.