Management of Caustic Esophageal Injury: A Survey Study in Türkiye and Review of the Literature

Abstract

Objectives: Management of caustic ingestion (CI) and esophageal burns are a serious problem which causes a significant burden on the health care services. Since absence of evidence-based guidelines optimal management of CI is still yet to be determined. The study aims to evaluate clinical approach of Turkish pediatric surgeons to caustic esophageal burns. Materials and Methods: The survey questions were prepared through a literature review for controversial issues. The survey was sent to 450 member of Turkish association of pediatric surgery via Google Forms and 106 of them responded. Results: There were 46 (43%) participants who do not perform endoscopy in whether symptomatic or asymptomatic patients in the first apply. Sixty (56%) participants preferred to perform endoscopy at the first apply. Thirty-six (34%) of participants perform endoscopy in case of certain ingestion of caustic substance, 14 (13.5%) perform in only symptomatic patients and 10 (9.5%) perform endoscopy in any suspicion of caustic ingestion. Seventy-one (67%) of the participants declared that they do not use antibiotics routinely and forty-six (45%) stated that they do not use steroids with or without esophageal burns. Conclusion: Although some studies on CI management have been published, a clear algorithm in management of CI has not established yet. Clinicians tend to determine different follow-up and treatment algorithms based on clinical customs and their experience.

Keywords

• Caustics
• endoscopy
• esophageal stricture

Kostik Özofagus Yaralanmasının Yönetimi: Türkiye’de Bir Anket Çalışması ve Literatürün Gözden Geçirilmesi

Abstract

Amaç: Kostik alımı ve özofagus yanıklarının tedavisi, sağlık hizmetleri üzerinde önemli bir yük oluşturan ciddi bir sorundur. Kanıta dayalı kılavuzların bulunmaması nedeniyle kostik alımının optimal yönetimi henüz belirlenmemiştir. Çalışma, Türk çocuk cerrahlarının kostik özofagus yanıklarına klinik yaklaşımını değerlendirmeyi amaçlamaktadır. Gereç ve Yöntem: Anket soruları tartışmalı konulara ilişkin literatür taraması yoluyla hazırlanmıştır. Anket, Türkiye Çocuk Cerrahisi Derneği’nin 450 üyesine Google Formlar aracılığıyla gönderildi ve 106’ı yanıt verdi. Bulgular: İlk başvuruda semptomatik veya asemptomatik hastalara endoskopi yapmayan 46 (%43) katılımcı vardı. Altmış (%56) katılımcı ilk başvuruda endoskopi yapmayı tercih etti. Katılımcıların 36’sı (%34) kesin kostik madde alımı durumunda endoskopi yaparken, 14’ü (%13,5) sadece semptomatik hastalarda, 10’u (%9,5) herhangi bir kostik madde alımı şüphesi varsa endoskopi yapıyor. Katılımcıların 71’i (%67) rutin olarak antibiyotik kullanmadığını, 46’sı (%45) özofagus yanığı olsun ya da olmasın steroid kullanmadığını belirtti. Sonuç: Kostik alımı yönetimine ilişkin bazı güçlü çalışmalar yayınlanmış olmasına rağmen, yönetimi konusunda net bir algoritma henüz oluşturulmamıştır. Klinisyenler klinik geleneklere ve deneyimlerine göre farklı takip ve tedavi algoritmaları belirleme eğilimindedir.

Keywords

• Kostik madde
• endoskopi
• özofagus darlığı

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