Esophageal complications following aluminium phosphide ingestion: an emerging issue among survivors of poisoning.

Aluminium phosphide ingestion is the most common agricultural poisoning in suburban and rural India and with a high mortality rate. Among survivors of acute poisoning there are recent sporadic reports of esophageal complications such as esophageal strictures and tracheo-esophageal fistula. The present study was carried out to determine the incidence, natural history, and treatment outcome of local esophageal complications in survivors of aluminium phosphide poisoning with complaints of dysphagia. All confirmed cases of poisoning with aluminium phosphide ingestion were admitted in Hamidia Hospital, Gandhi Medical College, Bhopal, Madhya Pradesh, India, from October 2007 to October 2008. Survivors with complaints of dysphagia underwent a barium study and upper gastrointestinal endoscopy to determine site and nature of esophageal complications. All cases of strictures were treated with fluoroscopy-guided Savary-Gilliard bougie dilation, and patients with tracheo-esophageal fistula underwent surgery. Of 104 confirmed cases, 31 survived. Ten survivors with dysphagia were found to have single short-segment esophageal stricture and two patients with odynophagia and swallow-cough sequence had tracheo-esophageal fistula. All cases of esophageal strictures responded successfully to Savary-Gilliard dilation in six to ten sessions without any major complications. Patients with tracheo-esophageal fistula were treated successfully via surgery. Nearly one-third of survivors of aluminium phosphide ingestion developed esophageal complications. Hence, we conclude that all survivors of aluminium phosphide poisoning must undergo barium swallow and endoscopic examination for early detection of esophageal complications. Prevention of esophageal complications after aluminium phosphide ingestion needs to be given adequate attention because tracheo-esophageal fistula and esophageal stricture are associated with high morbidity. When one finds esophageal stricture or fistula, the possibility of aluminium phosphide ingestion should always be considered.

Rigiflex pneumatic dilation of achalasia without fluoroscopy: a novel office procedure.

BACKGROUND: Pneumatic balloon dilation is the most effective nonsurgical treatment to relieve functional obstruction of the gastroesophageal junction in achalasia. Since its inception, the conventional technique has been performed under direct fluoroscopic control with or without a guidewire. To overcome the impediments of the conventional technique and radiation exposure, we have devised a novel technique of achalasia dilation without fluoroscopy. The aim of the study was to evaluate the efficacy, the safety, and the outcome of the new method. METHODS: Fifty-six patients (34 men, 22 women) (mean age 32 years) with achalasia cardia were subjected, over a span of 2 years, to dilation with a Gruntzig-type (Rigiflex balloon) pneumatic dilator with the new technique. Clinical response and complications were assessed. OBSERVATIONS: Excellent improvement in dysphagia, pain, and regurgitation was observed in 92.9%, 89.3%, and 89.3% patients at 24 hours, 6 weeks, and 6 months after dilation, respectively. The mean time to maneuver the Rigiflex balloon to the antrum was 30 seconds. The procedure was successfully done in all patients, and there were no procedural failures. The mean time of the procedure was 8 minutes. There were no complications or mortality during the study. CONCLUSIONS: Achalasia dilation with this new technique has excellent results and is devoid of the side effects of radiation. It can be done as an office procedure, without the need of a fluoroscopy setup.