Caustic injury: can CT grading system enable prediction of esophageal stricture?
BACKGROUND
The aim of this study was to test the utility of our computed tomography (CT) grading system, compared with endoscopy, for association with the development of esophageal stricture in patients with caustic ingestion.


METHODS
This retrospective case series involved 49 patients with caustic ingestion from 1998 to 2009. The degree of esophageal damage was graded using a scoring system based on the extent of esophageal wall edema and the damage in adjacent tissue as seen on thoracoabdominal CT scans. The presence of esophageal stricture was established by esophagography. Diagnostic performance was compared using receiver operating characteristic (ROC) analysis. Sensitivity and specificity were calculated for the grading system.


RESULTS
The CT grading score results showed that grade III was the most common injury (20 cases, 40.8%), followed by grade IV (14 cases, 28.6%), grade II (9 cases, 18.4%), and grade I (6 cases, 12.2%). In addition, damage to the esophagus was significantly correlated with esophageal stricture when the extent of damage approached grades III and IV (p < 0.001). The CT grading system for esophageal stricture resulted in a slightly larger area under the receiver operating characteristic curve (0.90) compared with endoscopic grading system (0.79). The sensitivity and specificity of CT grading system were moderately higher than those of endoscopic grading system.


CONCLUSIONS
Assessment of the degree of esophageal damage using CT, a noninvasive modality, in patients who visit the emergency department following caustic ingestion should be useful in estimating the occurrence of complications including esophageal stricture.
Ryu
Hyun Ho
HH
Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Jeung
Kyung Woon
KW
Lee
Byung Kook
BK
Uhm
Jun Hwan
JH
Park
Young Hun
YH
Shin
Min Ho
MH
Kim
Hyun Lee
HL
Heo
Tag
T
Min
Yong Il
YI
D000328:Adult; D000368:Aged; D002057:Burns, Chemical / Q000175:diagnosis / Q000473:pathology*; D002424:Caustics / Q000633:toxicity*; D004636:Emergency Service, Hospital; D004940:Esophageal Stenosis / Q000139:chemically induced*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*
D002424:Caustics