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Caustic Injury of the Upper GI Tract: Who Needs Dilatation or Surgery?
Sarah Larson*, Charles E. Lucas, Choichi Sugawa
Surgery, Wayne State University, Detroit, MI
Objective: Caustic ingestion injuries range from mild mucosal irritation to full-thickness necrosis perforation. This study aimed to identify factors associated with the need for dilatation or surgery.
Methods: The records of 108 consecutive adult patients from 1980 through 2012 admitted to an urban emergency hospital for ingestion of caustic materials were examined retrospectively for caustic agent, endoscopic grade, dilatation or surgery and outcome. There were 69 men and 39 women with an average age of 37 years (range 17 to 81). Ingestion was due to a suicide attempt in 56 patients and accidental in 52 patients.
Results: The ingested agents were strong acid in 17 patients, strong alkalis in 32, commercial bleach in 29, detergent in 18, ammonia in 5, an unknown substance in 5, a cleaner in 1 and hydrogen peroxide in 1. All patients had endoscopic evaluation. Ten patients had no endoscopic evidence of mucosal damage. Grade I superficial mucosal injury was found in 58. Grade II moderate injury with submucosal damage was discovered in 27 patients. Deep grade III transmural injury was found in 13. Strong acids and strong alkali were more likely to produce grade III injury while bleach, detergent and ammonia usually caused grade I injury. Eleven of the 13 patients with grade III injury required operative intervention including total gastrectomy in 3 patients, hemigastrectomy in 1, esophagectomy in 4, tracheostomy in 2 and jejunostomy in 1. Six out of 27 with grade II injury required surgery including hemigastrectomy in 2 and esophagectomy in 2. No patients with grade I injury required surgical intervention. Eleven patients with esophageal injury eventually required dilation for stricture. Endoscopic grading correlated with late esophageal stricture.
Conclusions: Grade I injuries heal spontaneously. Grade II injuries may be treated conservatively, but repeat endoscopy should be considered to identify the need for intervention and to assess for late complications such as stricture. Grade III injuries typically require surgical intervention.
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