Role of endoscopy in caustic injury of the esophagus

Abstract

Caustic injury of the esophagus is a problematic condition challenging endoscopists worldwide. Although the caustic agents and motives are different among countries and age groups, endoscopy still plays an invaluable role in diagnosis and treatment. Endoscopy can determine the severity of caustic ingestion which is of great importance in choosing appropriate treatment. However, some aspects of endoscopy in diagnosis of caustic injury remain controversial. Whether or not all patients need endoscopy, when to perform endoscopy and how to assess the severity are just some examples of these controversies. Due to lack of randomized controlled trials, many findings and suggestions are inconclusive. Computerized tomography scan of the chest and abdomen gains popularity in assessing the severity of caustic injury and avoiding unnecessary surgery. If esophageal stricture eventually develops, endoscopic dilatation is a mainstay. Maneuvers such as steroid injection and esophageal stent may be used in a refractory stricture. Nevertheless, some patients have to undergo surgery in spite of vigorous attempts with esophageal dilatation. To date, caustic injury remains a difficult situation. This article reviews all aspects of caustic injury of the esophagus focusing on endoscopic role. Pre-endoscopic management, endoscopy and its technique in acute and late phase of caustic injury including the endoscopic management of refractory stricture, and the treatment outcomes following each endoscopic intervention are thoroughly discussed. Finally, the role of endoscopy in the long term follow-up of patients with esophageal caustic injury is addressed.

Corrosive Esophagitis and Gastritis Induced by Glutaraldehyde Ingestion

“…16 Although the necessity or timing of follow-up endoscopy during hospitalization has not been clearly investigated, there are some reports where balloon dilatation or stent insertion can be performed due to stricture formation, in early chronic phase (3 weeks to 6 months). 17,18 In addition, regular endoscopic examination during the long-term follow-up peroid is recommended, since the incidence of esophageal cancer increases after several decades from the event.…”

Household cleaning products poisoning in a pediatric emergency center: A 10- year cross-sectional study and literature review

“…3,4,9 It is essential to rapidly establish hemodynamic stability and protect the airway after caustic ingestion. 3,24 If clinical features of caustic injury are evident or highly suspected, 16 PES should be performed to determine injury severity; 17,21 a nasogastric tube may be required if esophageal stenosis is J o u r n a l P r e -p r o o f possible. 3,8,15,17,24 The European Society of Gastrointestinal Endoscopy and European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines do not mention the use of antacids or antibiotics, but in some studies antacids (omeprazole or pantoprazole) and antibiotics (thirdgeneration cephalosporins) were prescribed within 48 hrs.…”

“…14,19,20 Patients with a Zargar grade ≥ 3 were considered to have severe caustic injuries. 9,21,22 Long-term follow-up has been suggested for children with corrosive esophageal burns, severe corrosive esophageal injuries, or diffuse esophageal erosions with segmental strictures 23 (Figure 1B). Follow-up was scheduled every 1or 2 weeks and was then gradually extended to 13 months depending on the severity of caustic injury.…”

Esophageal Stricture Caused by the Ingestion of Undissolved Picosulfate Powder

“…There is no consensus about the ideal timing and method of endoscopic management of corrosive esophageal injury [ 14 ]. Endoscopic dilation with bougination or ballooning is generally recommended as first line treatment, and esophageal stents are used for caustic strictures resistant to dilation [ 14 ].…”

“…There is no consensus about the ideal timing and method of endoscopic management of corrosive esophageal injury [ 14 ]. Endoscopic dilation with bougination or ballooning is generally recommended as first line treatment, and esophageal stents are used for caustic strictures resistant to dilation [ 14 ]. However, a recent study reported that esophageal dilation for caustic esophageal injury failed in three-fourths of the patients studied, and that long stricture length is a risk factor for failure [ 15 ].…”