Emergency computed tomography evaluation of caustic ingestion
Michela Assalino1, Matthieu Resche-Rigon2, Helene Corte1
1Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France.
Summary
Computed tomography (CT) safely assesses caustic ingestion injuries, potentially eliminating the need for emergency endoscopy. This study found similar survival rates whether patients underwent CT alone or CT with endoscopy.
Area of Science:
- Gastroenterology
- Emergency Medicine
- Radiology
Background:
- Computed tomography (CT) is increasingly used for emergency assessment of caustic injuries.
- The necessity of emergency endoscopy for caustic ingestion is being questioned.
- Evaluating modern outcomes and the feasibility of abandoning emergency endoscopy is crucial.
Purpose of the Study:
- To evaluate the outcomes of caustic ingestion in the modern era.
- To assess the feasibility of abandoning emergency endoscopy in favor of CT evaluation.
- To compare outcomes between patients managed with CT and endoscopy versus CT alone.
Main Methods:
- A cohort of 414 patients admitted for caustic ingestion between 2013 and 2019 was analyzed.
- Patients were divided into groups managed by CT with endoscopy (n=120) and CT alone (n=294).
- Propensity score-based analysis and standard mortality ratio (SMR) were used for comparison.
Main Results:
- Overall complication rate was 23%, with a 90-day mortality of 4.1%.
- Intentional ingestion, age, and CT grade of esophageal injuries independently predicted survival.
- Crude and propensity match analyses showed similar survival rates for management with and without endoscopy.
Conclusions:
- Computed tomography (CT) evaluation alone can be safely used for the emergency management of caustic ingestion.
- The CT grade of esophageal injuries is the sole independent predictor of successful management.
- Abandoning routine emergency endoscopy appears feasible for patients with caustic ingestion.
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