Caustic ingestion in adults: the role of endoscopic classification in predicting outcome.
BACKGROUND
The ingestion of caustic substances induces an extensive spectrum of injuries to the aerodigestive tract which include extensive necrosis and perforation of the esophagus and stomach. The gold standard of safely assessing depth, extent of injury, and appropriate therapeutic regimen is esophagogastroduodenoscopy (EGD). The objective of this study was to report our clinical experience and to evaluate the role of a 6-point EGD classification system of injury in predicting outcomes in adult patients diagnosed with caustic agent ingestion.


METHODS
The study was a retrospective medical chart review from 273 patients admitted to the Chang Gung Memorial Hospital in Tao-Yuan, Taiwan between June 1999 and July 2006 for treatment of caustic ingestion. The patients underwent EGD within 24 hours of admission and mucosal damage was graded using Zagar's modified endoscopic classification scheme. After treatment, patients were followed in the outpatient clinic for a minimum of 6 months.


RESULTS
A total of 273 patients were included for analysis. Grade 3b injury was the most common caustic injury (n = 82, 30.03%), followed by grade 2b injuries (n = 62, 22.71%). Stricture was the most common complication (n = 66, 24.18%), followed by aspiration pneumonia (n = 31, 11.36%), and respiratory failure (n = 21, 7.69%). Compared to grade 3a mucosal injury, grade 3b mucosal injuries were at greater risk of prolonged hospital stay (odds ratio [OR]: 2.44; 95% confidence interval [CI]: 1.25-4.80), ICU admission (OR: 10.82; 95% CI: 2.05-200.39), and gastrointestinal (OR: 4.15; 95% CI: 1.55-13.29) and systemic complications (OR: 4.07; 95% CI: 1.81-14.07).


CONCLUSIONS
In patients with caustic ingestion, EGD should be performed within 12 to 24 hours and categorized according to a 6-point scale. Patients with grade 3b burns identified on endoscopy have high rates of morbidity. The 6-point scale is useful for predicting immediate and long-term complications, and guiding appropriate therapy.
Cheng
Hao-Tsai
HT
Division of Digestive Therapeutic Endoscopy, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan. Hautai@adm.cgmh.org.tw
Cheng
Chi-Liang
CL
Lin
Cheng-Hui
CH
Tang
Jui-Hsiang
JH
Chu
Yin-Yi
YY
Liu
Nai-Jen
NJ
Chen
Pang-Chi
PC
D000328:Adult; D002057:Burns, Chemical / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D002424:Caustics / Q000506:poisoning*; D004435:Eating; D016145:Endoscopy, Digestive System / Q000145:classification*; D004940:Esophageal Stenosis / Q000139:chemically induced; D004947:Esophagus / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000293:injuries; D011015:Pneumonia, Aspiration / Q000139:chemically induced; D011237:Predictive Value of Tests; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000139:chemically induced; D012189:Retrospective Studies; D013270:Stomach / Q000293:injuries*
D002424:Caustics