Caustic ingestion in children treated at a tertiary centre in South Africa: can upper endoscopy be omitted in asymptomatic patients?

Abstract

Considering that clinical presentation and gastrointestinal tract (GIT) injuries post-caustic ingestion vary in children, this study aims to establish whether a correlation exists between clinical presentation and endoscopic findings. This retrospective study comprised patients referred to a paediatric surgical unit between 2016 and 2018 within 72h post-caustic ingestion. Data collected included caustic agents ingested, clinical presentation, endoscopic findings and management. Oesophageal injuries were graded according to the Zargar's endoscopic classification and gastric injuries classified as mild to severe. Fifty patients with a mean age of 2.4years were managed during the study period. Potassium permanganate (KMNO4) was the most frequently ingested substance in 27 (54%) patients. All 30 (60%) asymptomatic patients had no positive endoscopic findings regardless of clinical signs. Among the symptomatic patients (n = 20), 15 (75%) had oesophageal injuries (p = 0.01). Stridor was associated with a higher grade of oesophageal injury (p = 0.007). Clinical signs and symptoms post-caustic ingestion correlated with endoscopic findings in our study. Endoscopy can be safely omitted in asymptomatic patients, including those with isolated staining secondary to KMNO4 ingestion. Symptomatic patients should have an endoscopy performed within 48-72h of the insult to diagnose injuries.