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Caustic ingestion in children: is endoscopy always indicated? The results of an Italian multicenter observational

Pietro Betalli1, Diego Falchetti, Stefano Giuliani

  • 1Pediatric Surgery Clinic, University of Padova, Padova, Italy.

Gastrointestinal Endoscopy
|May 2, 2008
PubMed

Insights

Caustic ingestion in children rarely causes severe esophageal lesions without symptoms. Endoscopy may be avoided in asymptomatic cases, but is crucial for symptomatic children, as symptom severity predicts damage.

Area of Science:

  • Pediatric Gastroenterology
  • Toxicology
  • Emergency Medicine

Background:

  • Accidental caustic substance ingestion is a significant pediatric health concern.
  • The necessity of urgent endoscopy in children, especially asymptomatic ones, remains debated.

Purpose of the Study:

  • To investigate the predictive value of clinical signs and symptoms in identifying severe esophageal lesions following caustic ingestion in children.
  • To inform clinical decision-making regarding the need for urgent endoscopy.

Main Methods:

  • A multicenter observational study analyzed data from 162 children with accidental caustic ingestion.
  • Signs and symptoms were categorized as minor (oral lesions, vomiting) or major (dyspnea, dysphagia, drooling, hematemesis).
  • All patients underwent endoscopy within 12–24 hours; correlations between ingested substances, symptoms, and injury severity were examined.

Main Results:

  • Mild esophageal lesions occurred in 88.3% of patients, while severe (third-degree) lesions were found in 11.7%.
  • The risk of severe lesions was very low in asymptomatic children (OR 0.13).
  • The presence of three or more symptoms significantly predicted severe lesions (OR 11.97), with symptoms being the strongest predictor in multivariate analysis (OR 2.3).

Conclusions:

  • The incidence of severe (third-degree) esophageal lesions without early signs or symptoms is low, suggesting endoscopy might be avoidable in such cases.
  • The risk of severe esophageal damage increases with the number of presenting signs and symptoms.
  • Urgent endoscopy is consistently recommended for all symptomatic pediatric patients following caustic ingestion.
Abstract

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