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Endoscopy 2017; 49(07): 643-650
DOI: 10.1055/s-0043-104857
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Relook endoscopy predicts the development of esophageal and antropyloric stenosis better than immediate endoscopy in patients with caustic ingestion

Rakesh Kochhar
1   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Munish Ashat
2   Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
,
Yalaka Rami Reddy
1   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Narender Dhaka
1   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Manish Manrai
1   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Saroj K. Sinha
1   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Usha Dutta
1   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Thakur D. Yadav
3   Department of Gastroenterology and General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Vikas Gupta
3   Department of Gastroenterology and General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
› Author Affiliations
Further Information

Publication History

submitted 09 October 2016

accepted after revision 06 February 2017

Publication Date:
04 May 2017 (online)

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Abstract

Background and aims Early ( < 24 hours) esophagogastroduodenoscopy (EGD) is used to prognosticate mucosal injury after caustic ingestion. We aimed to compare differences in endoscopic grading on EGDs performed on day 5 and day 1 and to assess the impact of relook endoscopy findings on the development of esophageal and/or antropyloric cicatrization.

Patients and methods Consecutive patients admitted within 24 hours of caustic ingestion between 2009 and 2014 underwent EGD and had their mucosal changes graded. Injuries of grade ≤ 2a were classified as mild and ≥ 2b were classified as severe. Patients were followed up for the development of cicatrization and managed per protocol. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) were calculated to compare day 1 and day 5 EGD findings.

Results A total of 62 patients (35 men; mean age 33 ± 15) underwent both day 1 and day 5 EGDs. Antropyloric stenosis developed in 16 patients, esophageal strictures in nine, and four had both esophageal and antropyloric strictures. Compared with day 1 EGD, endoscopic grading of severe injury on day 5 had higher specificity (83 % vs. 65 %), higher PPV (60 % vs. 41 %), and higher positive LR (5.65 vs. 2.66) for predicting the development of esophageal stricture. Similarly, day 5 endoscopic grading had higher specificity (95 % vs. 61 %), higher PPV (88 % vs. 54 %), and higher positive LR (16 vs. 2.5) for predicting the development of antropyloric stenosis.

Conclusion Endoscopic assessment on day 5 is a better predictor of esophageal and gastric cicatrization than day 1 EGD, which significantly overestimates the grade of injury.

 

  • References

  • 1 Cabral C, Chirica M, de Chaisemartin C. et al. Caustic injuries of the upper digestive tract: a population observational study. Surg Endosc 2012; 26: 214-221
    CrossrefPubMedGoogle Scholar
  • 2 Cheng HT, Cheng CL, Lin CH. et al. Caustic ingestion in adults: the role of endoscopic classification in predicting outcome. BMC Gastroenterol 2008; 8: 31
    CrossrefPubMedGoogle Scholar
  • 3 Lu LS, Tai WC, Hu ML. et al. Predicting the progress of caustic injury to complicated gastric outlet obstruction and esophageal stricture, using modified endoscopic mucosal injury grading scale. BioMed Res Int 2014; 2014: 919870
    PubMedGoogle Scholar
  • 4 Park KS. Evaluation and management of caustic injuries from ingestion of acid or alkaline substances. Clin Endosc 2014; 47: 301-307
    CrossrefPubMedGoogle Scholar
  • 5 Poley JW, Steyerberg EW, Kuipers EJ. et al. Ingestion of acid and alkaline agents: outcome and prognostic value of early upper endoscopy. Gastrointest Endosc 2004; 60: 372-377
    CrossrefPubMedGoogle Scholar
  • 6 Ramasamy K, Gumaste VV. Corrosive ingestion in adults. J Clin Gastroenterol 2003; 37: 119-124
    CrossrefPubMedGoogle Scholar
  • 7 Rigo GP, Camellini L, Azzolini F. et al. What is the utility of selected clinical and endoscopic parameters in predicting the risk of death after caustic ingestion?. Endoscopy 2002; 34: 304-310
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Zargar SA, Kochhar R, Mehta S. et al. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc 1991; 37: 165-169
    CrossrefPubMedGoogle Scholar
  • 9 Keh SM, Onyekwelu N, McManus K. et al. Corrosive injury to upper gastrointestinal tract: Still a major surgical dilemma. World J Gastroenterol 2006; 12: 5223-5228
    PubMedGoogle Scholar
  • 10 Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol 2013; 19: 3918-3930
    CrossrefPubMedGoogle Scholar
  • 11 Zargar SA, Kochhar R, Nagi B. et al. Ingestion of corrosive acids. Spectrum of injury to upper gastrointestinal tract and natural history. Gastroenterology 1989; 97: 702-707
    CrossrefPubMedGoogle Scholar
  • 12 Zargar SA, Kochhar R, Nagi B. et al. Ingestion of strong corrosive alkalis: spectrum of injury to upper gastrointestinal tract and natural history. Am J Gastroenterol 1992; 87: 337-341
    PubMedGoogle Scholar
  • 13 Quingking CG, Dioquino C, Pascual J. Predictive factors of gastrointestinal caustic injury according to clinical and endoscopic findings. Asia Pac J Med Toxicol 2013; 2: 19-22
    PubMedGoogle Scholar
  • 14 Gorman RL, Khin-Maung-Gyi MT, Klein-Schwartz W. et al. Initial symptoms as predictors of esophageal injury in alkaline corrosive ingestions. Am J Emerg Med 1992; 10: 189-194
    CrossrefPubMedGoogle Scholar
  • 15 Boskovic A, Stankovic I. Predictability of gastroesophageal caustic injury from clinical findings: is endoscopy mandatory in children?. Eur J Gastroenterol Hepatol 2014; 26: 499-503
    CrossrefPubMedGoogle Scholar
  • 16 Havanond C, Havanond P. Initial signs and symptoms as prognostic indicators of severe gastrointestinal tract injury due to corrosive ingestion. J Emerg Med 2007; 33: 349-353
    CrossrefPubMedGoogle Scholar
  • 17 Nunez O, Gonzalez-Asanza C, de la Cruz G. et al. [Study of predictive factors of severe digestive lesions due to caustics ingestion]. Med Clin (Barc) 2004; 123: 611-614
    PubMedGoogle Scholar
  • 18 Crain EF, Gershel JC, Mezey AP. Caustic ingestions. Symptoms as predictors of esophageal injury. Am J Dis Child 1984; 138: 863-865
    CrossrefPubMedGoogle Scholar
  • 19 [Anonymous]. Provision of gastrointestinal endoscopy and related services for a district general hospital. Working Party of the Clinical Services Committee of the British Society of Gastroenterology. Gut 1991; 32: 95-105
    CrossrefPubMedGoogle Scholar
  • 20 Tohda G, Sugawa C, Gayer C. et al. Clinical evaluation and management of caustic injury in the upper gastrointestinal tract in 95 adult patients in an urban medical center. Surg Endosc 2008; 22: 1119-1125
    CrossrefPubMedGoogle Scholar
  • 21 Mittal BR, Bhoil A, Kashyap R. et al. (99m)Tc-pertechnetate scintigraphy and endoscopy in assessment of caustic-induced gastric mucosal injury. Clin Nucl Med 2013; 38: e146-e147
    CrossrefPubMedGoogle Scholar
  • 22 Sunil HV, Mittal BR, Bhattacharya A. et al. Pertechnetate SPECT-CT in corrosive gastric injury. Ind J Gastroenterol 2010; 29: 244-246
    PubMedGoogle Scholar
  • 23 Kochhar R, Poornachandra KS, Puri P. et al. Comparative evaluation of nasoenteral feeding and jejunostomy feeding in acute corrosive injury: a retrospective analysis. Gastrointest Endosc 2009; 70: 874-880
    CrossrefPubMedGoogle Scholar
  • 24 Pelclova D, Navratil T. Do corticosteroids prevent oesophageal stricture after corrosive ingestion?. Toxicol Rev 2005; 24: 125-129
    CrossrefPubMedGoogle Scholar
  • 25 Fulton JA, Hoffman RS. Steroids in second degree caustic burns of the esophagus: a systematic pooled analysis of fifty years of human data: 1956–2006. Clin Toxicol 2007; 45: 402-408
    CrossrefPubMedGoogle Scholar
  • 26 Kochhar R, Dutta U, Sethy PK. et al. Endoscopic balloon dilation in caustic-induced chronic gastric outlet obstruction. Gastrointest Endosc 2009; 69: 800-805
    CrossrefPubMedGoogle Scholar
  • 27 Bonnici KS, Wood DM, Dargan PI. Should computerised tomography replace endoscopy in the evaluation of symptomatic ingestion of corrosive substances?. Clin Toxicol 2014; 52: 911-925
    CrossrefPubMedGoogle Scholar
  • 28 Chirica M, Brette MD, Faron M. et al. Upper digestive tract reconstruction for caustic injuries. Ann Surg 2015; 261: 894-901
    CrossrefPubMedGoogle Scholar
  • 29 Isbister GK, Page CB. Early endoscopy or CT in caustic injuries: a re-evaluation of clinical practice. Clin Toxicol 2011; 49: 641-642
    CrossrefPubMedGoogle Scholar
  • 30 Ryu HH, Jeung KW, Lee BK. et al. Caustic injury: can CT grading system enable prediction of esophageal stricture?. Clin Toxicol 2010; 48: 137-142
    CrossrefPubMedGoogle Scholar
  • 31 Cheng H-T, Cheng C-L, Lin C-H. et al. Caustic ingestion in adults: The role of endoscopic classification in predicting outcome. BMC Gastroenterol 2008; 8: 1-7
    CrossrefPubMedGoogle Scholar
  • 32 Maull KI, Scher LA, Greenfield LJ. Surgical implications of acid ingestion. Surg Gynecol Obstet 1979; 148: 895-898
    PubMedGoogle Scholar
  • 33 Wang WL, Wu ZH, Sun Q. et al. Meta-analysis: the use of carbon dioxide insufflation vs. room air insufflation for gastrointestinal endoscopy. Aliment Pharmacol Therap 2012; 35: 1145-1154
    CrossrefPubMedGoogle Scholar
  • 34 Dellon ES, Hawk JS, Grimm IS. et al. The use of carbon dioxide for insufflation during GI endoscopy: a systematic review. Gastrointest Endosc 2009; 69: 843-849
    CrossrefPubMedGoogle Scholar
  • 35 Lo SK, Fujii-Lau LL. ASGE Technology Committee. et al. The use of carbon dioxide in gastrointestinal endoscopy. Gastrointest Endosc 2016; 83: 857-865
    CrossrefPubMedGoogle Scholar
  • 36 Chirica M, Resche-Rigon M, Zagdanski AM. et al. Computed tomography evaluation of esophagogastric necrosis after caustic ingestion. Ann Surg 2016; 264: 107-113
    CrossrefPubMedGoogle Scholar
  • 37 Chiu HM, Lin JT, Huang SP. et al. Prediction of bleeding and stricture formation after corrosive ingestion by EUS concurrent with upper endoscopy. Gastrointest Endosc 2004; 60: 827-833
    CrossrefPubMedGoogle Scholar
  • 38 Kamijo Y, Kondo I, Kokuto M. et al. Miniprobe ultrasonography for determining prognosis in corrosive esophagitis. Am J Gastroenterol 2004; 99: 851-854-p
    CrossrefPubMedGoogle Scholar