From the Guidelines
Endoscopy is recommended within 12-48 hours after acid ingestion to assess the extent of damage to the esophagus and determine prognosis and management. This timing allows for early identification of potential complications, such as stricture formation, and guides treatment decisions 1. The procedure should be performed by an experienced endoscopist using gentle air insufflations or preferably with CO2 to minimize the risk of perforation.
Key Considerations
- Contraindications to endoscopy include radiological suspicion of perforation or burns to the supraglottic and epiglottic areas 1.
- The use of oral steroids, antibiotics, mitomycin C, and intraluminal stents to prevent stricture formation is not supported by strong evidence 1.
- Timely management of oesophageal strictures with dilatation is crucial to improve patient outcomes 1.
Management Approach
- Perform upper gastrointestinal tract endoscopy within the first 12–48 hours after caustic ingestion to determine prognosis and management 1.
- Ensure timely management of oesophageal strictures with dilatation to prevent long-term complications 1.
- Consider the use of bougie or balloon dilators for dilatation, as there is no clear advantage of one technique over another 1.
From the Research
Acid Ingestion Endoscopy
- Acid ingestion can cause a wide range of injuries to the upper gastrointestinal tract, and endoscopy plays a crucial role in evaluating the severity of the injury 2.
- The severity of the injury can be graded using endoscopy, with grade I being superficial, grade II being moderate, and grade III being deep 2, 3.
- Endoscopic findings can predict the onset of complications, including late esophageal stricture, and guide appropriate therapy 2, 4.
- The role of endoscopy in caustic injury of the esophagus is invaluable, and it can determine the severity of the injury, which is essential in choosing the appropriate treatment 4.
Endoscopic Classification and Outcome
- A 6-point endoscopic classification system can be used to predict outcomes in adult patients with caustic ingestion, with grade 3b injuries being associated with higher rates of morbidity 3.
- Patients with grade 3b burns identified on endoscopy have high rates of prolonged hospital stay, ICU admission, and gastrointestinal and systemic complications 3.
- Endoscopic findings and outcome can differ between acid and alkali ingestion, with alkali ingestion resulting in higher grades of esophageal and stomach injuries 5.
Management and Complications
- Endoscopy can play a major role in the initial evaluation and subsequent therapy of caustic injuries, including the management of esophageal and pyloric strictures 6.
- Complications of caustic ingestion can include stricture, aspiration pneumonia, and respiratory failure, and endoscopy can help identify these complications early on 2, 3.
- Surgical interventions, mechanical ventilation, and tracheotomy may be required in some cases, especially in patients with severe injuries or complications 5.