Ingestion Of Caustic Agents Research Articles

Protocolo diagnóstico y terapéutico de la ingesta de cáusticos

The ingestion of caustic agents is a medical emergency due to the serious injuries they can cause to the upper digestive tract. It is estimated to have a frequency of 38.7 cases/100,000 inhabitants and a mortality rate of 1%–4% in Western countries. There are two typical scenarios: accidental ingestion, of small quantity and with a more benign course, and ingestion with the purpose of self-harm, of larger quantity and with a worse prognosis. The initial management consists of ensuring hemodynamic stability and airway permeability, avoiding actions such as inducing vomiting or the use of neutralizing substances. Radiological tests together with endoscopy allow for assessing severity and stratifying the risk of complications. Treatment varies according to the Zargar classification, ranging from outpatient management to emergency surgery in cases of perforation. Long-term follow-up allows for the detection of complications such as esophageal stricture, esophagobronchial fistulas, and esophageal cancer.

Clinical evaluation and treatment outcomes of caustic ingestion injuries in Syrian pediatric patients: A retrospective study: Short title: High-dose steroids for pediatric caustic ingestions in Syria.

Accidental ingestion of caustic agents poses a significant concern in pediatric emergency departments globally. It is a growing public health concern in low-to-middle income countries, which often lack comprehensive data reporting. This study examines high doses of corticosteroid treatment outcomes of caustic ingestion injuries in Syrian pediatric patients, addressing clinical features, and associated variables. A retrospective observational study was conducted at University Pediatric Hospital from January 2016 to January 2019. Medical records were reviewed for patients aged <10 years with esophagoscopy-confirmed grade IIa, IIb, or III burns. Data collected included sociodemographics, esophagoscopy results, treatment details, and outcomes. Among 114 pediatric patients, 76 (67%) were males and 38 (33%) were females. Age groups included <1 year (11%), 1-3 years (39%), 3-5 years (29%), 5-7 years (11%), and >7 years (11%). Alkaline burns accounted for 54% of injuries, acidic for 32%, and other substances for 13%. Complications included bleeding (19%) and psychomotor disability (7%). The most common burn site was the entire esophagus (62%), with 81% having grade II burns. Healing was achieved in 71% of patients with high doses of corticosteroids treatment, and 29% required dilation, with final 92% healing rate. The use of corticosteroids for esophageal strictures remains inconclusive, demanding further robust research with larger sample sizes and control groups. While our study revealed that high doses of corticosteroids treatment followed by esophageal dilation had a 92% success rate. However, our study demonstrates promising results, methodological limitations and absence of a control group underscore the need for more definitive evidence. Both alkali and acidic ingestion contribute to stricture development.

Assessment the Risk Factors for the Complications of Gastric Pull-Up Method in Esophageal Stenosis due to Ingestion of Caustic Agents

Assessment the Risk Factors for the Complications of Gastric Pull-Up Method in Esophageal Stenosis due to Ingestion of Caustic Agents

Predicting Factors of Clinical Outcomes in Patients Hospitalized after Esophageal Foreign Body or Caustic Injuries: The Experience of a Tertiary Center

Ingestion of foreign bodies (IFB) and ingestion of caustic agents are frequent non-hemorrhagic causes of endoscopic urgencies, with the potential for severe complications. This study aimed to evaluate the predicting factors of the clinical outcomes of patients hospitalized as a result of IFB or ingestion of caustics (IC). This was a retrospective single-center study of patients admitted for IFB or IC between 2000 and 2019 at a tertiary center. Demographic and clinical data, as well as preliminary exams, were evaluated. Also, variables of the clinical outcomes, including the length of stay (LS) and other inpatient complications, were assessed. Sixty-six patients were included (44 IFB and 22 IC). The median LS was 7 days, with no differences between the groups (p = 0.07). The values of C-reactive protein (CRP) upon admission correlated with the LS in the IFB group (p &lt; 0.01) but not with that of those admitted after IC. In the IFB patients, a diagnosis of perforation on both an endoscopy (p = 0.02) and CT scan (p &lt; 0.01) was correlated with the LS. The Zargar classification was not correlated with the LS in the IC patients (p = 0.36). However, it was correlated with antibiotics, nosocomial pneumonia and an increased need for intensive care treatment. CT assessment of the severity of the caustic lesions did not correlate with the LS. In patients admitted for IFB, CRP values may help stratify the probability of complications. In patients admitted due to IC, the Zargar classification may help to predict inpatient complications, but it does not correlate with the LS.

A rare case of congenital adult pharyngeal web causing airway obstruction managed by coblation technology

Congenital pharyngeal web is a rare anomaly almost always diagnosed in the paediatric population due to airway obstruction and feeding difficulties. The combination of congenital oropharyngeal and laryngopharyngeal web in an adult is extremely rare and has not commonly been published in the literature. We experienced a 47-year-old woman undiagnosed with pharyngeal web until difficult intubation upon surgery. A 47-year-old woman diagnosed with right ovarian complex cyst was scheduled for total laparoscopic hysterectomy and bilateral salpingo-oopherectomy. pharyngeal webs were incidentally found during intubation and necessitated a reschedule of surgery and tracheostomy. The patient had no history of dysphagia, weight loss or other symptoms of airway obstruction. Fibre optic laryngoscopic examination revealed a combination of congenital oropharyngeal and laryngopharyngeal webs. Patient denied previous history of caustic agent ingestion, oral airway surgeries, chemoradiation. After 2 days, awake tracheostomy with endoscopic guided coblator assisted excision of pharyngeal web was done first, followed by total laparoscopic hysterectomy and bilateral salpingo-oopherectomy in the same sitting. Coblation assisted excision of the pharyngeal web will allow the airway to be feasible for intubation in the future. Congenital pharyngeal webs are extremely rare findings, especially in adult patients. Prediction of difficult airways preoperatively is necessary to prevent difficult airway situations. Controlled ablation of the pharyngeal web gives a good outcome in terms of less post-operative pain and blood loss.

Social factors behind rising trends of intentional ingestions of caustic agents in adult population of Pakistan. A study from tertiary health care center, Islamabad.

Objective To evaluate factors associated with rising trends of intentional ingestion of caustic agents for suicidal attempts in Pakistan. Study Design: Cross Sectional, Observational study. Setting: Tertiary Health Care Center of Islamabad. Period: January 2019 to December 2020. Material &amp; Methods: One hundred subjects with intentional ingestion of caustic ingestion treated in Gastroenterology unit were interviewed on a written questioner after their recovery and informed consent. Non-probability purposive was sampling method used. Results: Out of 100 patients 63% were female, mean age was 28.81 years and 58% had suicidal intension. Disturbed marital/ family life was main factor behind suicidal attempts. (P= 0.025). Conclusion: factors like female gender, younger age, poor socioeconomic status and disturbed marital/ family life in study group had statistically significant association with suicidal intentions.

Reconstruction of the upper gastrointestinal tract using intra-thoracic Roux-en-Y technique after caustic agent ingestion: a case report from Aleppo, Syria

BackgroundCaustic substance ingestion is a high-risk medical emergency associated with high mortality and morbidity. To date, there are several treatment options with no standard method of care.Case presentationWe report a case of a corrosive agent ingestion complicated with third-degree burns and severe stenosis of the esophagus and gastric outlet. After failure of conservative treatment, the patient underwent jejunostomy placement for nutritional support followed by transhiatal esophagectomy with gastric pull-up and intra-thoracic Roux-en-Y gastroenterostomy with good outcomes. The patient recovered from the procedure and has been tolerating oral intake very well with significant weight gain.ConclusionWe put a new technique for treating severe gastrointestinal injuries caused by corrosive agent ingestion that resulted in both esophageal and gastric outlet strictures. These rare complex cases requires difficult treatment decisions. We believe that this technique provides many benefits for such cases and might be a feasible alternative for colon interposition.

Effectiveness of sucralfate in preventing esophageal stricture in children after ingestion of caustic agents.

Ingestion of caustic agents by children is a serious health issue that can affect the patient for the rest of his life. The role of sucralfate in preventing stricture caused by caustic agents is controversial, and limited studies have been conducted in this field. We aimed to investigate the effect of sucralfate on preventing esophageal stricture in children. Sixty children with mean age of 36.69 ± 20.50months and grade II B esophageal burns due to ingestion of caustic agents were enrolled in the study. In the intervention group, in addition to the usual treatment, sucralfate was administered orally at a dose of 80mg/kg every 2h for 3days. For the control group, only the usual treatment was prescribed. Stricture development was compared between groups based on endoscopic and radiologic findings. Of the 60 patients enrolled in the study, 53 were examined. The incidence of esophageal stricture in the intervention group was significantly lower than in the control group (37% versus 67%, P-value = 0.042). In addition, the odds of esophageal stricture after sucralfate intervention was significantly reduced after adjustment for potential confounders (OR = 0.198, P-value = 0.031). Conclusions: The results of this study showed that sucralfate may reduce the development of esophageal stricture in children when used to manage IIB esophageal burns due to ingestion of caustic agents. What is Known: •Ingestion of caustic agents by children is a serious health issue that can affect the patient for the rest of his life. •The role of sucralfate in preventing stricture caused by caustic agents is controversial and limited studies have been conducted in this field. What is New: • It seems that sucralfate significantly reduces the incidence of esophageal stricture following the ingestion of caustic agents in children compared to the control group. •We believe that the prognosis may be improved and the risk of stricture formation may be reduced with high doses of sucralfate therapy in grade IIB esophageal injury.

Colon interposition in the management of post-corrosive strictures

: Stricture of the esophagus is the most frequent late sequelae of the ingestion of caustic agents. It is disabling, lead to chronic pain and malnutrition. Endoscopic dilatation still remains the first-line management but cannot be effective in all patients. When surgery is indicated, only selected patients can be submitted to an esophago-gastroplasty. Colon interposition for esophageal replacement is more frequently performed for treatment of caustic burns, but many questions still remain about colonic tract to be used (right or left), route of transposition and timing of the operation. Surgeon’s experience is the most important factor to choose the right colonic tract as esophageal substitute. Age, psychiatric disorders, massive ingestion, emergency tracheotomy, extended visceral resections, short delays in reconstruction, and pharyngeal involvement worsen surgical outcomes, therefore surgery should be performed in high-volume centers. Follow-up of these patients should not tend only to verify the patency of the transit and weight maintenance, but it should identify any lesion of the graft and any metabolic alteration referring to an altered permeability of the transposed colic segment. In this review, we present the main step of preoperative, intraoperative and postoperative pathway of esophageal reconstruction for caustic strictures with a colonic graft, critically exposed according to our experience.

657. COMPARISON BETWEEN GASTRIC TUBE AND COLOPLASTY IN ESOPHAGECTOMY AND ESOPHAGEAL BYPASS IN ESOPHAGEAL STENOSIS DUE TO INGESTION CORROSIVE SUBSTANCE

Abstract The treatment of ingestion of caustic agents is controversial in the literature. Surgical therapy has been shown to be the best way to proceed, but the surgical methodology has been varied according to the patient's involvement. This study aims to expose the experience of a single institution in relation to the methodology used for the surgical treatment of esophageal stenosis by ingestion of a caustic substance. A retrospective study was carried out in which data were collected from 27 patients who underwent a surgical procedure for the treatment of esophageal stenosis due to alkali ingestion at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between 2010 and 2019 and their subsequent comparison between the conduits used in the surgical intervention. Fisher's test was performed to compare the groups regarding cervical leakage and post-surgical symptoms with a significance level of 5%. Of the 27 surgical procedures for esophageal stenosis due to alkali ingestion, 12 performed gastric conduits and 15 colon conduits. When comparing the groups regarding cervical leaks, no statistically significant difference was noted (p = 0.7060). There were also no statistically significant differences regarding the presence of symptoms in the postoperative period (p &amp;gt; 0.99...) Surgical intervention by both gastric and colon conduits showed no differences in cervical leakage and symptom control. Surgical intervention by both gastric and colon conduits showed no differences in cervical leakage and symptom control.

Benign Esophageal Stricture

Benign esophageal strictures, characterized by fibrotic narrowing of the esophageal lumen, are frequently encountered in clinical practice. Benign esophageal strictures are associated with a multifactorial etiology and may occur across various age and population groups. Common causes of benign esophageal strictures include gastroesophageal reflux disease (peptic stricture), esophageal injury secondary to surgery (anastomotic strictures), radiotherapy, caustic agent ingestion, or endoscopic resection. Benign esophageal strictures are categorized into simple and complex types based on their size, area involved, surface features, extent of luminal narrowing, and margins. Esophageal strictures often present clinically with dysphagia and may lead to severe complications. Regardless of the underlying cause, therapy is aimed at relief of dysphagia and prevention of stricture recurrence. Benign esophageal strictures are commonly treated using endoscopic balloon or bougie dilation, followed by disease-specific approaches to treat underlying inflammation. However, based on the underlying cause, the risk of recurrence of benign esophageal strictures is 10~30%. Therapeutic options for refractory or recurrent esophageal strictures include endoscopic incisional therapy, esophageal stent placement, or intralesional injection of steroids or mitomycin C. The pathophysiology of esophageal strictures is complicated, and thorough understanding and patient cooperation are important for optimal management. Physicians should familiarize themselves with the various dilation strategies available and their application for management of specific types of stenotic lesions. In this article, we review the evaluation and management of patients with esophageal strictures.

Long term outcome of a subcutaneous colonic interposition after pharyngo-laryngectomy for strictures of the larynx and hypopharynx resulting from caustic ingestion: A case report.

IntroductionCaustic agents, also called corrosive agents, could be acids or alkali in nature. If ingested, these agents can injure any part of the aerodigestive tree. Extent of injury depends on the type, concentration, duration of exposure and volume of caustic agent ingested. Serious complications after caustic agent ingestion can occur both in the short term such as hollow viscus perforation and death and in the long term such as stricture formation causing obstruction and lifetime risk of development of carcinoma.Presentation of a caseThis is a case of a 25-year-old female who ingested an unknown substance resulting to a severe stricture of the larynx, hypopharynx, esophagus and pyloroantral region of the stomach. Six months after her tracheostomy and tube jejunostomy, she sought further medical attention in our institution due to inability to swallow food and saliva. She underwent pharyngolaryngectomy (PL) with the strictured esophagus and stomach left in-situ due to extensive adhesions. The subcutaneous colonic interposition reestablished the alimentary continuity by providing enough length for tension-free anastomosis and a more direct route for cervical anastomosis.DiscussionStricture formation is one of the most challenging late complication of corrosive injury. It results from scar formation in response to inflammation of the aerodigestive tract. Key factors in managing caustic strictures include safety of strictured segment resection, choice of replacement organ for reconstruction and route of conduit.ConclusionTiming of surgery and proper selection the surgical procedure for complications of caustic ingestion can result in excellent long term outcomes.

Sequelae of Corrosive Injury in Children: An Observational Study.

Aim:This study aims to determine the sequelae of corrosive ingestion in children.Methods:A retrospective study was conducted in the Department of Pediatric Surgery at a Tertiary Center. The children presenting between January 2015 and December 2020 with a history of ingestion of caustic agents were included in the study.Results:A total of 26 children were included in the study. The children with suicidal attempts were significantly older than those who ingested the corrosive agents accidentally (14.2 ± 1.9 years vs. 6 ± 3.3 years; P < 0.01; Student's t-test). Sixteen (62%) children had esophageal strictures, 8 (31%) had pyloric strictures, and a child (4%) had both esophageal and gastric strictures. Eight (31%) children required an initial feeding jejunostomy and 6 (23%) required a feeding gastrostomy as they had significant weight loss on presentation. Eleven (65%) esophageal strictures responded to the dilatation regimen and are symptom-free on follow-up. Three (18%) children with esophageal stricture underwent esophageal replacement. Eight (31%) children had a pyloric stricture and all of them were treated with a modified Billroth I gastro-duodenostomy. The children who presented after 2 months were found to have a significantly increased need for esophageal replacement (3/9 vs. 0/17; P = 0.03; Fischer's exact test).Conclusion:The corrosive ingestion in children is associated with higher morbidity. The sequelae include esophageal and antro-pyloric strictures. A feeding gastrostomy or jejunostomy was required in more than half of the patients. The children presenting after 2 months of ingestion were associated with an increased need for esophageal replacement.

PYLORIC STENOSIS CAUSED BY INGESTION OF CORROSIVE AGENTS : A CASE REPORT

&lt;p&gt;Corrosive or caustic is a group of chemical which has the capacity to cause tissue injury on contact by a chemical reaction.Ingestion of a substance that causes a chemical reaction with mucosal tissue and injures the gastrointestinal and respiratory tract is caustic ingestion. Accidental ingestion of caustic agents may cause devastating injury in children. Eighty percent of corrosive poisoning occurs in children below five years. Children are particularly susceptible to the accidental exposure to such substances due to inadequate parental supervision and careless storing of these chemicals at homes. Pyloric stenosis or gastric outlet obstruction is a well-known complication of caustic acid ingestion. The stenosis mostly occurs at the pylorus and antrum due to the pooling of the corrosive agent and the reflex pyloric spasm of the stomach after the ingestion. Typically corrosive acid ingestion leads to local reaction, oesophageal damage and gastric injury in that order. Isolated injury to the stomach resulting in pyloric stenosis is very rare, accounting to as little as 3,8% of all the cases of corrosive ingestion as reported in literature. A proper management including surgery is needed in this case to treat a child with pyloric stenosis caused by ingestion of corrosive agents.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;Keyword : Pyloric stenosis, accidental ingestion, corrosive agents.&lt;/p&gt;

Long term evolution of caustic induced esophagitis: A descriptive 20-years cohort.

Introduction: Corrosive esophagitis following caustic agent ingestion remains a significant medical and social concern in Tunisia. Secondary stricture is the most challenging complication. The aim of this study is to determine the incidence of caustic esophageal injuries and to highlight the characteristics of the management. Methods: Over a 20 years period, we conducted a retrospective and descriptive study about 164 consecutive patients presented to our department following ingestion of caustic agents. Results: The mean age was 26 years (16-87) with a gender ratio of 0.2. The ingestion was accidental in 58% of cases and as a suicidal attempt in 42%. Bleach largely dominates ingested solutions in 78.3 % of cases. The delay of the consultation was less than 12 hours in 98.4% of cases. We noticed gravity signs in eight patients. Lesions in Esophagoscopy were recorded in 62 patients (37.8%). The esophageal injury assessed as grade I in 36 patients, grade IIa limited lesions in 10 patients, grade IIa extensive in 8 patients, grade IIb in 5 patients and grade III in 3 patients. During the follow-up, 26 patients (41.9%) had a second assessment during the secondary stage, only 4 patients (2.4%) presented esophageal strictures. Three patients underwent coloplasty for esophageal replacement. Conclusion: During a 20-year period, 164 cases of caustic ingestion were reported. Constituted esophagitis injuries were noted in 37.8% and strictures in 6.45% of all cases.

Cuerpos extraños y cáusticos en el tracto digestivo superior

Foreign bodies (FB) ingestion is the second commonest cause of endoscopic emergency, causing sometimes severe complications. In patients suspected of FB or caustic substance ingestion is mandatory to verify both airway permeability and related complications. Anamnesis will give information regarding features of FB or caustic substances ingested. Radiologic test can provide FB location data as well as complication data. «Gold standard» for the diagnosis of caustic lesions is the gastroscopy. Endoscopic removal has to performed in 6 first hours in the following cases: complete esophageal obstruction, batteries placed in esophagus and stabbing/cutting FB. In remaining cases, depending on FB type and location, endoscopy can be carried out among 24-48hours. In cases of body-packers ingestion or perforation suspicion, endoscopy retrieve is contraindicated. Provoked vomiting, attempts to neutralize or to dilute the corrosive agent, are contraindicated in caustic agent ingestion. Therapeutic strategy varies according with endoscopic findings (Zargar's classification).

3100 Acute Esophageal Necrosis (Gurvits Syndrome) in a 78-Year-Old Male Filipino Patient

INTRODUCTION: Acute Esophageal Necrosis (AEN), also known as Gurvits Syndrome and commonly referred to as Black Esophagus, is a rare life-threatening clinical entity with an estimated prevalence of 1 to 200 in 100,000 and a mortality rate of approximately 30%. Only 88 patients over a span of 40 years have been reported. It is associated with geriatric males, diabetes mellitus, GERD, CKD, hypertension, vascular disease, alcohol abuse, malnourishment, ingestion of caustic agents and some medications. These factors predispose a patient to AEN through hemodynamic compromise, low-flow states, tissue hypoperfusion, corrosive injury and diminished mucosal defenses. Upper GI bleeding is the presenting complaint in around 90% of cases. It is diagnosed on endoscopy where characteristically, a diffuse, circumferential, necrotic esophageal mucosa is seen. The treatment for AEN aims to address the underlying medical illness, maintain and restore hemodynamic stability with intravenous fluid resuscitation and blood transfusions, attain complete esophageal rest, gastric acid suppression and antimicrobials. CASE DESCRIPTION/METHODS: A 78-year-old Filipino man developed hematemesis on a background of T2DM, hypertension, NSAID use and excessive alcohol use. He had no GI signs or symptoms prior to this episode. Four hours later he became drowsy and confused and was noted to be in hyperosmolar hyperglycemic state. An endoscopy revealed a distinctly diffuse circumferential necrosis of the esophagus with abrupt demarcation at the gastroesophageal junction. The gastric mucosa and biopsies were unremarkable. CT showed a distended aperistaltic esophagus with circumferential thickening with no evidence of perforation. Post endoscopy he was treated in ICU where he was maintained on parenteral nutrition, meropenem, nystatin, pantoprazole and insulin. Repeat endoscopy 7 days later showed pink mucosa after appropriate glycemic control, bowel rest and hemodynamic stabilization. He was discharged 3 days later. DISCUSSION: This is the first known report of a Filipino diagnosed with AEN. He presented with hematemesis, many of the risk factors associated with AEN, and his endoscopic findings were classic for AEN. However, he was only diagnosed sometime after endoscopy. This case highlights that AEN may be underdiagnosed and that clinicians should be mindful of it as populations develop more co-morbidities and risk factors that predispose them to developing it. This case also highlights the reversibility of this life-threatening condition.

Foregut caustic injuries: results of the world society of emergency surgery consensus conference.

IntroductionLesions 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.Purpose of the studyThe 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.MethodsAn 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).ResultsOne-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.ConclusionsThe 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.

Miralax Mix Up: A Case Report on Caustic Injury to the Esophagus

Introduction: Ingestion of caustic agents causes a variety of injuries to the esophagus making management difficult. We describe an interesting case of ingestion of an unknown caustic agent and briefly discuss the current recommendations on diagnosis and treatment. Case Report: A 68-year-old Caucasian male presented with a 2 day history of painful swallowing after drinking what he believed was Miralax with water. The patient denied any recent antibiotic or steroid use. The patient’s past medical and surgical history is significant for congestive heart failure status post defibrillator, type 2 diabetes mellitus, coronary artery disease status CABG, bipolar disorder, tobacco abuse and polysubstance abuse. On evaluation, the patient’s vital signs were within normal limits. Physical exam was remarkable for scattered white patches on the surface of the oropharynx, which revealed a denuded area when removed by scraping with a tongue blade. Labs were significant for an elevated white blood cell count of 17,500. Basic metabolic panel was within normal limits. Examination by a fiberoptic nasolaryngoscope revealed burns of the oropharynx and hypopharynx. Esophagogastroduodenoscopy (EGD) showed severe diffuse esophageal injury (Grade 2A/2B) likely related to an inadvertent caustic ingestion. Patient was treated with a proton pump inhibitor drip and broad spectrum antibiotics. After several days, the patient was able to tolerate a clear liquid diet. He continued to improve clinically and was discharged on a soft diet with crushed medications. A follow-up EGD was scheduled for 8 weeks. Discussion: Ingestion of caustic agents occurs most commonly by accident in the pediatric population and as a suicide attempt in adults. These agents include both acidic and alkali chemicals commonly found in household cleaning products, which cause tissue injury resulting in both systemic and focal injuries. Most serious and long-term complications occur in the esophagus and include esophageal ulcerations, edema, perforation, strictures, and an increased lifetime risk for carcinoma. Presenting symptoms can vary from no symptoms to life threatening symptoms depending on the extent of tissue damage. Endoscopy should ideally be performed within 24 hours of ingestion. A 6-point grading system based on endoscopy findings is often used to predict clinical outcomes and treatment plans. Treatment is mainly focused on supportive care depending on the extent of injury and often includes gastric acid suppression and broad spectrum antibiotics until the patient recovers and complications such as strictures and perforations are treated.

Endoscopic therapy in the treatment of caustic esophageal stricture: A retrospective case series study

Endoscopic procedures, such as balloon/bougie dilation and stent implantation, have gained increasing potential as the treatment of corrosive esophageal stricture. The purpose of the present retrospective case series study was to assess clinical outcomes of endoscopic therapy of esophageal strictures after caustic injury. Between January 2003 and December 2009, 13 admitted patients that developed esophageal stricture after caustic agent ingestion underwent endoscopic therapy at the First Affiliated Hospital of Nanjing Medical University. Data such as age, gender, caustic agents, site of burn, type of treatment, effectiveness and outcome of endoscopic therapy were recorded. The average follow up was 39 months with a range of 29-70 months. Successful endoscopic therapy was achieved in 12 of 13 patients (92%). Duration of stricture resolution was between 4 and 48 months (mean, 15 months). Among them, seven patients required dilations only, whereas the other five patients received both dilations and stent implantation. There were no severe complications in these patients. These data suggest that endoscopic therapy is feasible, less invasive and effective for the management of caustic esophageal stricture. After repeat dilation and stenting, patients can achieve stricture resolution in approximately 15 months and avoid surgery.