Emergency Computed Tomography Predicts Caustic Esophageal Stricture Formation.

Area of Science:

• Gastroenterology
• Radiology
• Emergency Medicine

Background:

• Caustic ingestion can lead to esophageal stricture formation.
• Endoscopy is currently considered the best predictor of stricture development.

Purpose of the Study:

• To compare the accuracy of emergency computed tomography (CT) and endoscopy in predicting esophageal stricture risk following caustic ingestion.
• To evaluate a novel CT classification system for esophageal caustic injuries.

Main Methods:

• A CT classification system for esophageal caustic injuries was developed (Grade I, IIa, IIb).
• The accuracy of this CT classification and the Zargar endoscopic classification were compared in 152 patients who underwent esophageal preservation after caustic ingestion.
• Risk of stricture formation was assessed for each grade in both classification systems.

Main Results:

• Fifty-six percent of patients developed esophageal strictures.
• CT demonstrated higher accuracy in predicting stricture formation compared to endoscopy (AUC: 85.1% vs 77.8%).
• CT also performed comparably to a combined CT-endoscopy approach.

Conclusions:

• Emergency computed tomography (CT) is superior to endoscopy in predicting esophageal stricture formation after caustic ingestion.
• Emergency endoscopy may not be indispensable for the initial evaluation of caustic esophageal injuries.