Evaluation By Computed Tomography Or Endoscopy After The Caustic Ingestion: Is Radiological Evaluation Alone Enough?

Year 2024, Volume: 7 Issue: 4, 148 - 152, 30.12.2024

Kerem Kenarlı , Nazmi Gökhan Ünver , Fırathan Sarıaltın , Ahmet Burak Fedai , Erdoğan Deniz , Hasan Tankut Köseoğlu , Mevlüt Hamamcı , Mahmut Yüksel

https://doi.org/10.54996/anatolianjem.1507630

Abstract

Aim: We aimed to determine the correlation between endoscopic and computed tomography (CT) grading scores in patients presenting after caustic ingestion and to evaluate their effectiveness in predicting the severity of lesions.

Material and Methods: Patients aged 18 and older who presented to our emergency department due to caustic ingestion between 2019 and 2023 were included in the study. Clinical records of the patients were retrospectively analyzed.

Results: A total of 57 patients (27 males, 47.4%; 30 females, 52.6%) were included in the study. The mean age of the patients was 41.6 (±17.0) years. CT findings and emergency endoscopic evaluation results at the time of emergency department presentation were compared. When the CT scores were compared
with the Zargar classification, statistically significant similarities were found for both the esophagus and the stomach.

Conclusion: This study suggests that CT evaluation in patients presenting with caustic ingestion may be as effective as emergency endoscopy. Additionally, for patients identified by CT as having a low likelihood of requiring an endoscopic intervention, treatment and follow-up may be feasible without performing emergency endoscopy.

Keywords

Caustic ingestion, computed tomography, Zargar’s classification, mucosal injury, radiological classification

Ethical Statement

The study was conducted in strict adherence to the ethical principles outlined in the Declaration of Helsinki. Ethical sanction was obtained from the ethics committee at the local. (Date: 04.10.2023, Decision No: E1-23-4075).

Supporting Institution

None

Thanks

None

Kostik Madde Alımından Sonra Bilgisayarlı Tomografi veya Endoskopi ile Değerlendirme: Sadece Radyolojik Değerlendirme Yeterli mi?

Abstract

Amaç: Kostik madde alımı sonrası başvuran hastaların endoskopik ve bilgisayarlı tomografi derecelendirme skorları arasındaki korelasyonu belirlemeyi ve lezyon şiddetini öngörmedeki etkinliğini değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Çalışmaya hastanemiz acil servisine 20192023 yılları arasında kostik madde alımı sonrası başvuran 18 yaş üzeri hastalar dahil edildi. Hastaların klinik kayıtları retrospektif olarak analiz edildi.

Bulgular: Çalışmaya 57 hasta (27 erkek, %47,4; 30 kadın, %52,6) dahil edildi. Hastaların yaş ortalaması 41,6 (±17,0) yıl idi. Acil servise başvuruda yapılan bilgisayarlı tomografi ve acil endoskopik değerlendirme sonuçları karşılaştırıldı. Bilgisayarlı tomografi skoru ile Zargar sınıflaması karşılaştırıldığında sonuçlarda hem özofagus hem de mide için istatistiksel olarak anlamlı benzerlik bulundu.

Sonuç: Bu çalışma kostik madde alımı ile başvuran hastalarda bilgisayarlı tomografi değerlendirmesinin acil endoskopi kadar etkili olabileceğini düşündürmektedir. Ayrıca, bilgisayarlı tomografi ile endoskopik girişim gerektirme ihtimalinin düşük olduğu tespit edilen hastalar için, acil endoskopi yapılmadan tedavi ve takip mümkün görünmektedir.

Keywords

Kostik madde alımı, bilgisayarlı tomografi, Zargar sınıflaması, mukozal hasar, radyolojik sınıflama

References

• Chirica M, Bonavina L, Kelly MD, Sarfati E, Cattan P. Caustic ingestion. Lancet. 2017;389(10083):2041-52.
• Hugh TB, Kelly MD. Corrosive ingestion and the surgeon. J Am Coll Surg. 1999;189(5):508-22.
• Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol. 2013 Jul 7;19(25):3918-30
• Hoffman RS, Burns MM, Gosselin S. Ingestion of Caustic Substances. N Engl J Med. 2020 Apr 30;382(18):1739-1748.
• Hall AH, Jacquemin D, Henny D, Mathieu L, Josset P, Meyer B. Corrosive substances ingestion: a review. Crit Rev Toxicol. 2019 Sep;49(8):637669.
• Ramasamy K, Gumaste VV. Corrosive ingestion in adults. J Clin Gastroenterol. 2003 Aug;37(2):119-24.
• Ducoudray R, Mariani A, Corte H, et al. The Damage Pattern to the Gastrointestinal Tract Depends on the Nature of the Ingested Caustic Agent. World J Surg. 2016 Jul;40(7):1638-44.
• Chirica M, Resche-Rigon M, Bongrand NM, et al. Surgery for caustic injuries of the upper gastrointestinal tract. Ann Surg. 2012 Dec;256(6):994-1001.
• Chirica M, Jeune F, Corte H, Cattan P. Emergency Management of Caustic Injuries. Trauma Centers and Acute Care Surgery: A Novel Organizational and Cultural Model. 2021:249-57.
• Assalino M, Resche-Rigon M, Corte H, et al. Emergency computed tomography evaluation of caustic ingestion. Dis Esophagus. 2022 Nov 15;35(11):doac032.
• Chirica M, Resche-Rigon M, Pariente B, et al. Computed tomography evaluation of high-grade esophageal necrosis after corrosive ingestion to avoid unnecessary esophagectomy. Surg Endosc. 2015 Jun;29(6):1452-61.
• Gill M, Tee D, Chinnaratha MA. Caustic ingestion: Has the role of the gastroenterologist burnt out? Emerg Med Australas. 2019 Jun;31(3):479-482.
• Zargar SA, Kochhar R, Mehta S, Mehta SK. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc. 1991 Mar Apr;37(2):165-9.
• Barkun AN. Emergency endoscopy cover: cost and benefits? Gut. 2010 Aug;59(8):1012-4.
• Gorman RL, Khin-Maung-Gyi MT, Klein-Schwartz W, et al. Initial symptoms as predictors of esophageal injury in alkaline corrosive ingestions. Am J Emerg Med. 1992 May;10(3):189-94.
• Lamireau T, Rebouissoux L, Denis D, Lancelin F, Vergnes P, Fayon M. Accidental caustic ingestion in children: is endoscopy always mandatory? J Pediatr Gastroenterol Nutr. 2001 Jul;33(1):81-4.
• Cox AJ 3rd, Eisenbeis JF. Ingestion of caustic hair relaxer: is endoscopy necessary? Laryngoscope. 1997 Jul;107(7):897-902.
• Ba-Ssalamah A, Prokop M, Uffmann M, Pokieser P, Teleky B, Lechner G. Dedicated multidetector CT of the stomach: spectrum of diseases. Radiographics. 2003 May-Jun;23(3):625-44.
• Young CA, Menias CO, Bhalla S, Prasad SR. CT features of esophageal emergencies. Radiographics. 2008 Oct;28(6):1541-53.
• Chirica M, Kelly MD, Siboni S, et al. Esophageal emergencies: WSES guidelines. World J Emerg Surg. 2019 May 31;14:26
• Bruzzi M, Chirica M, Resche-Rigon M, et al. Emergency Computed Tomography Predicts Caustic Esophageal Stricture Formation. Ann Surg. 2019 Jul;270(1):109-114
• Chirica M, Resche-Rigon M, Zagdanski AM. Computed Tomography Evaluation of Esophagogastric Necrosis After Caustic Ingestion. Ann Surg. 2016 Jul;264(1):107-13.