PROBABILITY OF ESOPHAGEAL STRICTURE FORMATION AFTER CAUSTIC INGESTION IN CHILDREN AND THE NEED TO RETHINK EARLY MANAGEMENT STRATEGIES: META-ANALYSIS

Caustic ingestion remains a significant cause of esophageal injury in children worldwide, despite preventive measures and advances in emergency care. Although acute mortality has declined, long-term sequelae – particularly esophageal strictures – continue to represent a major clinical challenge, leading to chronic dysphagia, repeated interventions, impaired nutrition, and, in severe cases, complex reconstructive surgery. Historically, early restoration of oral intake and routine prophylactic esophageal dilatation were widely practiced to prevent cicatricial narrowing. However, accumulating evidence has questioned the safety and efficacy of these approaches, suggesting that early mechanical manipulation of the injured esophagus may exacerbate inflammation and fibrotic remodeling. Contemporary management increasingly emphasizes early endoscopic risk stratification, protection of the injured mucosa, delayed mechanical intervention, and individualized nutritional strategies. This review summarizes current epidemiological data, pathophysiological mechanisms of stricture formation, and the evolution of diagnostic and therapeutic approaches in pediatric caustic esophageal injuries. Particular attention is given to emerging concepts that support conservative early management and selective use of endoscopic and adjunctive therapies, aiming to optimize long-term outcomes and reduce the burden of post-caustic esophageal strictures in children.