title: Foregut caustic injuries: results of the world society of emergency surgery consensus conference.
abstract: BACKGROUND
  Lesions of the upper digestive tract due to ingestion of caustic agents still represent a major medical and surgical emergency worldwide. The work-up of these patients is poorly defined and no clear therapeutic guidelines are available.
  
  
  OBJECTIVE
  The aim of this study was to provide an evidence-based international consensus on primary and secondary prevention, diagnosis, staging, and treatment of this life-threatening and potentially disabling condition.
  
  
  METHODS
  An extensive literature search was performed by an international panel of experts under the auspices of the World Society of Emergency Surgery (WSES). The level of evidence of the screened publications was graded using the Oxford 2011 criteria. The level of evidence of the literature and the main topics regarding foregut caustic injuries were discussed during a dedicated meeting in Milan, Italy (April 2015), and during the 3rd Annual Congress of the World Society of Emergency Surgery in Jerusalem, Israel (July 2015).
  
  
  RESULTS
  One-hundred-forty-seven full papers which addressed the relevant clinical questions of the research were admitted to the consensus conference. There was an unanimous consensus on the fact that the current literature on foregut caustic injuries lacks homogeneous classification systems and prospective methodology. Moreover, the non-standardized definition of technical and clinical success precludes any accurate comparison of therapeutic modalities. Key recommendations and algorithms based on expert opinions, retrospective studies and literature reviews were proposed and approved during the final consensus conference. The clinical practice guidelines resulting from the consensus conference were approved by the WSES council.
  
  
  CONCLUSIONS
  The recommendations emerging from this consensus conference, although based on a low level of evidence, have important clinical implications. A world registry of foregut caustic injuries could be useful to collect a homogeneous data-base for prospective clinical studies that may help improving the current clinical practice guidelines.
authors.affiliation: Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bonavina
authors.affiliation: Department of Digestive Surgery, Saint-Louis Hospital, Paris, France.
authors.forename: Mircea
authors.initials: M
authors.lastname: Chirica
authors.affiliation: Department of Surgery, University of Belgrade, Belgrade, Serbia.
authors.forename: Ognjan
authors.initials: O
authors.lastname: Skrobic
authors.affiliation: Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Kluger
authors.affiliation: Department of Surgery, University of Campinas, Campinas, Brasil.
authors.forename: Nelson A
authors.initials: NA
authors.lastname: Andreollo
authors.affiliation: University of Parma, Parma, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Contini
authors.affiliation: Department of Surgery, University of Belgrade, Belgrade, Serbia.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Simic
authors.affiliation: General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
authors.affiliation: Emergency Surgery Department, Maggiore Parma Hospital, Parma, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.affiliation: Department of Surgery, University of Campinas, Campinas, Brasil.
authors.forename: Gustavo P
authors.initials: GP
authors.lastname: Fraga
authors.affiliation: Institute of Toxicology, University of Pavia, Pavia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Locatelli
authors.affiliation: Emergency Department, Niguarda Hospital, Milan, Italy.
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Chiara
authors.affiliation: Department of Surgery, University of Jerusalem, Jerusalem Rehovot, Israel.
authors.forename: Jeffry
authors.initials: J
authors.lastname: Kashuk
authors.affiliation: General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Coccolini
authors.affiliation: Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Macchitella
authors.affiliation: Department of Endoscopy, Niguarda Hospital, Milan, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mutignani
authors.affiliation: Department of Otolaryngology, Azienda Ospedaliera, Padova, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Cutrone
authors.affiliation: Intensive Care Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Marco Dei
authors.initials: MD
authors.lastname: Poli
authors.affiliation: Department of Anesthesiology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Tino
authors.initials: T
authors.lastname: Valetti
authors.affiliation: Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Asti
authors.affiliation: Department of Surgery, Wagga Wagga Hospital, Wagga Wagga, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Kelly
authors.affiliation: Department of Surgery, University of Belgrade, Belgrade, Serbia.
authors.forename: Predrag
authors.initials: P
authors.lastname: Pesko