From the Guidelines
Endoscopy is indicated within 12-48 hours after caustic ingestion to determine prognosis and management, including oesophageal stricture formation and subsequent requirement for dilatation. This recommendation is based on the most recent and highest quality study available, which suggests that upper gastrointestinal tract endoscopy should be performed within the first 12-48 hours after caustic ingestion to assess the extent of injury and guide management decisions 1.
Specific indications for endoscopy after caustic ingestion include:
- Persistent vomiting, dysphagia, or odynophagia
- Hematemesis or melena
- Respiratory distress or stridor suggesting airway involvement
- Severe abdominal pain or peritoneal signs
- Suspected perforation based on imaging findings
When performing endoscopy, it is essential to:
- Use minimal air insufflation to reduce the risk of perforation
- Avoid passing the endoscope beyond areas of severe injury
- Document the extent and grade of mucosal injury
The use of endoscopy in the management of caustic ingestion is supported by recent guidelines, which suggest that emergency endoscopy should be performed if CT is unavailable, CT with contrast administration is contraindicated, or in the pediatric population 1. Additionally, endoscopy remains the main diagnostic tool for esophageal/gastric strictures in symptomatic patients, and endoscopic dilation is the upfront treatment of esophageal strictures 1.
It is crucial to note that the role of emergency endoscopy evaluation of caustic injuries is currently reduced to situations in which CT cannot be employed, and the use of a CT-based algorithm to select patients for emergency surgery significantly improved patient outcomes when compared to endoscopy-based management 1. However, endoscopy is still a valuable tool in the management of caustic ingestion, particularly in the diagnosis and treatment of esophageal strictures.
In terms of timing, endoscopy should be performed within 12-48 hours after caustic ingestion, as this allows for the assessment of injury severity and guides management decisions 1. Immediate endoscopy (within 6 hours) is rarely needed for caustic ingestion unless there are signs of perforation or severe hemorrhage.
Overall, the use of endoscopy in the management of caustic ingestion should be guided by the most recent and highest quality evidence available, and endoscopy should be performed within 12-48 hours after caustic ingestion to determine prognosis and management.
From the Research
Indications for Endoscopy after Caustic Ingestion
The decision to perform an endoscopy after caustic ingestion depends on various factors, including the presence of symptoms, the type of substance ingested, and the patient's age.
- The presence of symptoms such as dyspnea, dysphagia, drooling, and hematemesis is a significant predictor of severe esophageal lesions 2.
- Asymptomatic patients who have ingested an alkaline product or are under the age of 6 years should also undergo endoscopy 3.
- Endoscopy is always mandatory in symptomatic patients, as the risk of severe damage increases proportionally with the number of signs and symptoms 2.
Predictive Factors for Severe Esophageal Injuries
Several studies have identified predictive factors for severe esophageal injuries, including:
- Alkaline ingestion 3
- Presence of symptoms after caustic ingestion 3
- Ingestion of strong acid or strong alkali 4, 5
- Presence of severe gastric lesions at the initial procedure 3
Role of Endoscopy in Caustic Injury
Endoscopy plays a crucial role in the diagnosis and treatment of caustic injury, including: