The Role of Early Upper Gastrointestinal Endoscopy (less than 24 hours and after) in the Management of Corrosive Ingestion in Adults "Liver and Gastrointestinal Diseases Research Center"

Document Type : Research Paper

Authors

1 Assistant Professor of General Surgery, Tabriz University of Medical Sciences,Tabriz, Iran

2 Associate Professor of Internal, TabrizUniversity of Medical Sciences,Tabriz, Iran

3 Resident, TabrizUniversity of Medical Sciences,Tabriz, Iran

Abstract

Introduction
Upper gastrointestinal (UGI) endoscopy is the most reliable modality for evaluating patients with caustic injury of GI tract; however there is an ongoing debate on its optimal timing.
 
Materials and Methods
 
100 adult patients with definite diagnosis of injury due to corrosive ingestion on direct laryngoscopy were evaluated in Tabriz Emam Khomeini Hospital during a 15-month period. The patients with signs and symptoms indicating a serious internal injury were operated immediately. In other patients, endoscopy was employed and according to timing, patients categorized in two groups; early (24 h). Inhospital condition of the two groups was compared.
 
Results
 
62 females and 38 males (25.51±9.25 y/o) were recruited. Alkaline materials were used in majority of cases (83%). Eight percent of the patients were operated immediately. Early endoscopy was employed in 37% of patients and 55% underwent late endoscopy. Endoscopy results were normal in 11%, grade I in 36%, grade II in 22%, grade III in 11% and grade IV lesion in 12% of the patients. There was no significant difference between the two groups regarding the need of operation, gap between admission and operation, need of ICU admit and its duration and inhospital morbidity and mortality. However, operation gap and ICU admit were apparently better in early endoscopy group and morbidity was lower in late endoscopy group.
 
Conclusion
 
Early and late endoscopy did not significantly affect inhospital condition of adult patients with corrosive ingestion. However, early endoscopy was apparently along with better results.

Keywords


1- Poley JW, Steyerberg EW, Kuipers EJ, Dees J, Hartmans R, Tilanus HW, et al. Ingestion of acid and alkaline agents:
outcome and prognostic value of early upper endoscopy.Gastrointest Endosc 2004; 60:372-327.
2- Satar S, Topal M, Kozaci N. Management of caustic substances by adults. Am J Ther 2004; 11:258-261.
3- Ramasamy K, Gumaste VV. Corrosive ingestion in adults. J Clin Gastroentrol 2003; 37: 119-124.
4- Arevalo-Silva C, Eliashar R, Wohlgelernter J, Elidan J, Gross M. Ingestion of caustic substanceL a 15 year
exprience. Laryngoscope 2006; 116:1422-1426.
5- Litovitz TL, Swartz WK, White S.Annual report of the American association of poison control centers. Am J Emerg
Med 2000; 19:337–395.
6- Gumaste VV, Dave PB. (1992). Ingestion of corrosive substances by adults. Am J Gastroenterol 1992; 87:1–5.
7- Moore WR. Caustic Ingestions. Clin Pediatr 1986; 25:192.
8- Castell DO, Richter J.The Esophagus.21sted. Philadelphia: Lippincott Williams and Wilkins;1999.p.557–564.
9- Cox AJ, Eisenbeis JF. Ingestion of Caustic hair relaxer: Is endoscopy necessary? Laryngoscope 1997; 107:897–902.
10- Zargar SA, Kochhar R, Nagar B. Ingestion of corrosive acid. Gastroenterology 1989; 97: 702–707.
11- Zargar SA, Kuchhar R, Mehta S. The role of fibroptic endoscopy in the management of corrosive ingestion and modified
endoscopic classification of burns. Gastrointest Endosc 1991; 37:165–169.
12- Mutaf O, Genc A, Herek O. Gastroesophageal reflux: A determinant in the outcome of caustic esophageal burns. J
Pediatr Surg 1996; 31:1494–1495.
13- Bautista A, Varela R, Villanueva A. Motor function of the esophagus after caustic burn. Eur J Pediatr Surg 1996;
6:204–207.
14- Nicosia JF, Thornton JP, Folk FA. Surgical management of corrosive gastric injuries. Ann Surg 1994; 180:139–143.
15- Dilwari JB, Sing S, Rao PN.Corrosive acid ingestion in man: A clinical and endoscopic study. Gut 1994; 25:183–187.
16- Hawkins DB, Demeter MJ, Barnett TE. Caustic ingestion: controversies in management. A review of 214 cases.
Laryngoscope 1990; 90:98–109.
17- McAuley CE, Steel DL, Webster MW. Late sequelae of gastric acid injury. Am J Surg 1995; 149:412–415.
18- Gore R, Levine M, Laufer I. Textbook of Gastrointestinal Radiology.4thed. Philadelphia: WB Saunders; 2000.p.2–14.
19- Harley EH, Collins MD. Liquid household bleach ingestion in children. Laryngoscope 1997; 107:122–125.
20- Ahsan S, Haupert M.Absence of esophageal injury in pediatric patients after hair relaxer ingestion. Arch
Otolaryngol Head Neck Surg 1999; 125:953–955.
21- Cheng HT, Cheng CL, Lin CH, Tang JH, Chu YY, Liu NJ, et al. Caustic ingestion in adults: the role of endoscopic
classification in predicting outcome.BMC Gastroenterol 2008; 8:31.
22- Havanond C. Clinical features of corrosive ingestion.J Med Assoc Thai 2003; 86:918-924.
23- Christesen HB. Ingestion of caustic agents. Epidemiology, pathogenesis, course, complications and prognosis.
Ugeskr Laeger 1993; 155:2379-2382.
24- Gupta SK, Croffie JM, Fitzgerald JF. Is esophagogastroduodenoscopy necessary in all caustic ingestions?J Pediatr
Gastroenterol Nutr 2001; 32:50-53.
25- Lahoti D, Broor SL. (1993). Corrosive injury to the upper gastrointestinal tract.Indian J Gastroenterol 1993;
12:135-141.
26- Gorman RL, Khin-Maung-Gyi MT, Klein-Schwartz W, Oderda GM, Benson B, Litovitz T, et al. Initial symptoms
as predictors of esophageal injury in alkaline corrosive ingestions. Am J Emerg Med 1992; 10:189-194.
27- Nuutinen M, Uhari M, Karvali T, Kouvalainen K.Consequences of caustic ingestions in children. Acta Paediatr
1994; 83:1200-1205.
28- Gaudreault P, Parent M, McGuigan MA. Predictability of esophageal injury from signs and symptoms: a study of
caustic ingestions in 378 children. Pediatrics 1993; 71:767–770.
29- Ferguson MK, Migliore M, Staszak VM. Early evaluation and therapy for caustic esophageal injury. Am J Surg
1999; 157:116–120. 
٤٢
30- Moore WR. Caustic ingestions: pathophysiology, diagnosis, and treatment. Clin Pediatr 1996; 25:192–196.
31- Friedman EM.Caustic ingestions and foreign bodies in the aerodigestive tract of children. Pediatr Clin North Am
1999; 36:1403–1410.
32- Ashcraft KW, Simon JL. Accidental caustic ingestion in childhood: a review: pathogenesis and current concepts of
treatment. Tex Med 1992; 68:86–88.
33- Gorman RL, Khin-Maung-Gyi MT, Klein-Schwartz W. Initial symptoms as predictors of esophageal injury in
alkaline corrosive ingestions. Am J Emerg Med 1992; 10:189–194.
34- Christesen HBT. (1995). Prediction of complications following unintentional caustic ingestion in children: is
endoscopy always necessary? Acta Paediatr 1995; 84:1177–1182.
35- Erdogan E, Eroglu E, Tekant G, Yeker Y, Emir H, Sarimurat N, et al. Management of esophagogastric corrosive
injuries in children. Eur J Pediatr Surg 2003; 13:289-293.
36- de Jong AL, Macdonald R, Ein S, Forte V, Turner A. Corrosive esophagitis in children: a 30-year review. Int J
Pediatr Otorhinolaryngol 2001; 57:203-211.
37- Keh SM, Onyekwelu N, McManus K, McGuigan J.Corrosive injury to upper gastrointestinal tract: Still a major
surgical dilemma.World J Gastroenterol 2006; 12:5223-5228.
38- Schaffer SB, Hebert AF. Caustic ingestion.J La State Med Soc 2000; 152:590-596.
39- Zargar SA, Kochhar R, Nagi B, Mehta S, Mehta SK. Ingestion of strong corrosive alkalis: spectrum of injury to
upper gastrointestinal tract and natural history.Am J Gastroenterol 1992; 87: 337-341.
40- Nunes AC, Romãozinho JM, Pontes JM, Rodrigues V, Ferreira M, Gomes D, et al. Risk factors for stricture
development after caustic ingestion.Hepatogastroenterology 2002; 49:1563-1566.
41- Andreoni B, Farina ML, Biffi R, Crosta C. Esophageal perforation and caustic injury: emergency management of
caustic ingestion.Dis Esophagus 1997; 10:95-100.
42- Romanczuk W, Korczowski R. The significance of early panendoscopy in caustic ingestion in children. Turk J
Pediatr 1992; 34:93-98.