Accidental caustic ingestion in children: is endoscopy always mandatory?
BACKGROUND
Patients who have experienced severe caustic injury to the gastrointestinal tract are at high risk of esophageal strictures. Early endoscopy is usually recommended systematically in children after caustic ingestion to assess the severity of the initial digestive lesions. The aim of this study was to determine the predictive value of clinical symptoms and ingested-substance types as markers of severe esophagogastric lesions and to define indications for endoscopy.


METHODS
Ingested-product types, clinical symptoms, endoscopic data and outcome were prospectively recorded in 85 children admitted after accidental caustic ingestion.


RESULTS
Forty-eight children (57%) had no symptoms; the others presented with vomiting, hematemesis, drooling, respiratory distress, and/or oropharyngeal lesions. Endoscopy showed no or minimal lesions in 63 cases (74%). None of the children developed digestive sequelae. Severe esophagogastric lesions were present in 22 cases (26%), mostly caused by lye ingestion (14 of 22) but also by strong acids (4 of 22); 9 of the 22 children (41%) developed esophageal stenosis. Vomiting, drooling, and oropharyngeal lesions did not predict severe endoscopic lesions. Hematemesis, respiratory distress, or presence of at least three of the symptoms was associated with severe lesions (positive predictive value = 1). The absence of symptoms was always associated with no or minimal lesions (negative predictive value = 1).


CONCLUSIONS
In conclusion, endoscopy is not recommended for children living in developed countries who are asymptomatic after accidental caustic ingestion.
Lamireau
T
T
Pediatric Emergency Care Unit, Department of Pediatric Gastroenterology, Children's Hospital, Place Amelie Raba Leon, 33077 Bordeaux Cedex, France. thierry.lamineau@chu-bordeaux.fr
Rebouissoux
L
L
Denis
D
D
Lancelin
F
F
Vergnes
P
P
Fayon
M
M
D000061:Accidents, Home; D000293:Adolescent; D002057:Burns, Chemical / Q000175:diagnosis*; D002424:Caustics / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000706:statistics & numerical data*; D004940:Esophageal Stenosis / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index
D002424:Caustics