Prediction of bleeding and stricture formation after corrosive ingestion by EUS concurrent with upper endoscopy.
BACKGROUND
Upper endoscopy provides information that can be used to predict complications and to facilitate clinical decisions for patients who have ingested corrosive substances. The role of EUS in corrosive injury has not been investigated. The aim of this study was to determine whether concurrent catheter-probe EUS provides additional information that predicts complications after corrosive injury.


METHODS
Eighteen patients were referred (from 1997 to 2003) for EGD and concurrent EUS within 24 hours after ingestion of a caustic agent. Two patients were excluded (1 pneumoperitoneum, 1 markedly swollen cricoarytenoid cartilage/epiglottis). The severity of injury in the different segments of the esophagus and stomach was graded (0, 1, 2a, 2b, 3a, 3b) by endoscopy and by EUS (0, M, SM, MP, SS). The development of complications during hospitalization and 3-month follow-up were recorded.


METHODS
All 16 patients underwent EGD with EUS without complication. The frequency of early and late complications increased as the endoscopic and the EUS severity grades increased. The accuracy of prediction of bleeding or stricture was 100% when endoscopic grade 3a was used as a cutoff. For EUS, the highest accuracy was observed in the prediction of bleeding (75%) and stricture (100%) when EUS grade MP was used as a cutoff.


CONCLUSIONS
EUS can be performed safely within 24 hours of ingestive of corrosive substances. However, when used in conjunction with conventional endoscopic observation, it does not increase the accuracy for prediction of early or late complications. Standard endoscopy alone is sufficient for evaluation and prediction of bleeding and stricture complications after corrosive injury in the upper-GI tract.
Chiu
Han-Mo
HM
Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Lin
Jaw-Town
JT
Huang
Shih-Pei
SP
Chen
Chien-Hwa
CH
Yang
Chang-Shueh
CS
Wang
Hsiu-Po
HP
D000328:Adult; D002057:Burns, Chemical / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D002424:Caustics / Q000009:adverse effects*; D003251:Constriction, Pathologic; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography; D004947:Esophagus / Q000293:injuries; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013270:Stomach / Q000000981:diagnostic imaging / Q000293:injuries
D002424:Caustics