Liver diseases and caustic ingestion

Two examples of how endoscopy saves lives at Kantha Bopha.

During the week of 10-14 November 2025, a Swiss mission led by four physicians and two nurses from the KiSpi took place at Kantha Bopha. Several topics, focused on the concrete needs of sick children and newborns, were addressed: intensive care, infectious diseases, nephrology, and gastroenterology. It is this last field that will be the focus of this article.

Here, we present two diseases for which the use of endoscopy can save lives. They occur rarely in Switzerland, but more frequently among Cambodian children: esophageal varices linked to liver diseases and esophageal strictures linked to caustic ingestion.

Esophageal varices

Portal vein obstruction leads to esophageal varices.

Esophageal varices are a dilation of the veins around the esophagus resulting from increased pressure in the portal vein due to an obstruction (1). In children, the most frequent causes of increased portal pressure are liver cirrhosis, mainly linked to infectious hepatitis, and portal vein thrombosis, mainly occurring after the placement of umbilical venous lines in newborns requiring advanced resuscitation care.

In a healthy person, venous blood from the digestive system is drained toward the liver through the portal vein and detoxified before being transported to the heart and lungs via the inferior vena cava to be re-oxygenated. An increase in portal vein pressure represents an obstacle to blood drainage: to simplify, imagine a clogged garden hose! This leads to blood backing up in the esophageal veins, dilating them and weakening their walls, but also in the spleen, increasing its volume and causing sequestration of platelets, blood cells essential for coagulation. Both factors increase the risk of hemorrhage – and this is the life-threatening risk for the patient.

Esophageal strictures

Lye water commonly used in khmer kitchen.

Caustic ingestion is, unfortunately, a frequent accident among Cambodian children. Families use small amounts of alkali lye liquid in the preparation of certain desserts, and too often, children open the bottle and drink from it, thinking it is water (2). In the acute phase, this can cause perforation of the esophagus; in the chronic phase, it can lead to partial closure of the esophagus – medically called a stricture –making it difficult or even impossible for food and liquids to reach the stomach. This ultimately leads to malnutrition, which then becomes the life-threatening element.

The usefulness of endoscopy

In both situations, endoscopy is an intervention that can save lives. Let us now look at how it works. An endoscope – a camera in the form of a tube – is inserted through the mouth and allows visualization of the inside of the esophagus, enabling the identification of the problem and/or its treatment.

In the case of varices, the aim of endoscopy is to perform ligations to reduce the risk of hemorrhagic rupture. A band ligation system (3a) is attached to the tip of the endoscope (3b), which is inserted into the esophagus (3c) in search of varices (3d); these are ligated using the device (3e-f). One session makes it possible to ligate three or four varices.

Bandligationssystem

Top row, from left: Band ligation system. Fixation to endoscope. Insertion into the mouth.

Bottom row, from left: Esophageal varices. Ligation of varice. Ligated varice.

For strictures, the aim is to dilate the diseased part of the esophagus (4a) to improve the passage of food and liquids toward the stomach. Dilatation is performed using a balloon, inserted across the narrowed area of the esophagus (4b) and inflated under radiologic control (4c-d). The process is repeated three or four times per session.

From left: Esophageal stricture. Balloon inserted. X-ray showing narrowed area of the oesophagus. X-ray showing balloon dilated.

Past and present situation

Until about fifteen years ago, the hospital had no access to endoscopy, which left children affected by these esophageal diseases with virtually no chance of survival. Thanks to collaboration between a Swiss mission led by Prof. Christian Braegger, a KiSpi pediatrician specialized in gastroenterology and nutrition, and the surgical team of Jayavarman VII, the mortality rate linked to these two diseases has significantly decreased.

This year, the mission with Prof. Braegger took care of several pediatric patients in such health conditions, like a 14 years old boy suffering from blood vomiting associated with anemia. For this reason, he was admitted at Kantha Bopha and endoscopy revealed severe esophageal varices. Four endoscopic ligation were performed at the surgery theater, and the teenager is now under close follow-up.

Further needs

However, there are still concrete and achievable possibilities for improvement. During the Swiss mission, Prof. Braegger gave a course on parenteral nutrition for children and newborns who cannot be fed through the digestive tract (5). He suggested that filters should be used for umbilical venous lines to reduce the risk of contamination of the equipment and, consequently, the formation of portal vein thrombosis mentioned at the beginning of the article. After this course, an informal exchange between the Swiss pediatrician and the Cambodian physicians made it possible to formulate the needs in this regard—an important first step toward obtaining the necessary equipment.

Prof. Braegger (middle) and physicians at Kanta Bopha.

Another important need is passive vaccine of hepatitis B virus. Being infected by this virus as a newborn can lead to lifelong consequences, like liver cirrhosis and then esophageal varices, as explained in this article. The passive vaccine tends to prevent it by the HBV’s antibodies delivery directly after birth before perinatal infection. Currently, nearly 5% of cambodian pregnant women have current hepatitis B infection and they still have to pay if they want to get the passive vaccine. However, a mission led by Prof. Fauchère, swiss neonatologist, is trying to provide them to the families for free. Here again, the improvement process is underway…

With warm regards from Siem Reap

Pierre

Sources:

MSD Manuals – Digestive disorder

Kantha Bopha – Mission from 10 to 14 November 2025

E, Bunthen et al. «Residual risk of mother-to-child transmission of HBV despite timely Hepatitis B vaccination : a major challenge to eliminate hepatitis B infection in Cambodia.» BMC infectious diseases vol. 23,1 261. 26 Apr. 2023, doi : 10.1186/s12879-023-08249-1