S3141 Severe Non-Hemorrhagic Esophageal Endoscopic Urgencies: Clinical Outcome and Predicting Factors

Abstract

INTRODUCTION: Caustic and foreign body ingestion represent a significant part of endoscopic urgencies and can lead to critical condition. A correct use and interpretation of diagnostic findings at admission is mandatory for risk stratification and subsequent clinical decision. METHODS: Retrospectively evaluate hemorrhagic urgencies, especially Foreign body ingestion (FBI) and caustic ingestion (CAI) admitted in our center between 2000 and 2019. RESULTS: Sixty-seven patients were included (M/F: 1.79, mean age 54.3 ± 13.3 years): 44 cases of FBI (most frequently animal bones) and 23 cases of CAI (most commonly Sodium Hypochlorite). The Charlson Comorbidity score index had a mean value of 3, with no significant difference between FBI and CAI groups. Psychiatric disease, namely alcoholism and depression affected 27 patients (40%) and was strongly associated with CAI and intentional ingestion (P < 0.0001). Among all patients, 66 had a mean length of hospitalization (LoH) of 15 days (CAI vs FBI, 24.9 vs 11.3 days, P 0.05). Blood tests at first day showed a mean value of C-reactive protein (CRP) of 68.9 mg/L in FBI group and 27.2mg/L in CAI group with a significant difference (P = 0.036) and significantly associated with LoH in the FBI group (P > 0.001), but not in CAI group. WBC had a mean value of 10.3 × 10^9/L in FBI and 11.3 × 10^9/L with no significant differences between FBI and CAI (P 0.28) and no significant association with LoH (P 0.37). EGDS was performed in most cases within the first 24 h. In the CAI group, esophageal involvement was complete in the 65% of the cases. Zargar classification showed a significant association with LoH in CAI group (P 0.042). In the FBI group, lacerations were recognized in 41.5% of the cases, while perforation was present in 29.3%, with no significant association with outcome. Among the findings of CT scan, edema of the esophageal wall was the most common finding in CAI group (P 0.02) and perforation in FBI group (P 0.006). In the CAI group, CT scan Severity Index was significantly associated with LoH (P 0.01), while the presence of perforation was the most significant factor in the FBI group (P 0.06).Table 1CONCLUSION: EGDS with Zargar Classification is useful for risk stratification in patients with caustic ingestion. CT scan Severity Index for caustics and the presence of perforation for foreign body ingestion are associated with severity of the condition. CRP at admission is an excellent and inexpensive predictor of clinical outcome in foreign ingestion cases.