Esophagogastroduodenoscopy Versus Thoracic Computed Tomography in Prediction of Caustic Stricture

Upper gastrointestinal tract stricture is the most common delayed complication following corrosive ingestion. Previous data showed that endoscopic examination can predict delayed caustic stricture. Currently, thoracic computed tomography (CT) is increasingly used in the initial phase for grading the severity of caustic injury. However, the ability to predict delayed caustic stricture by computed tomography remains unclear.

To compare the caustic stricture prediction between CT and EGD.

A prospective study was conducted in the Thammasat University Hospital, Thailand. Adult caustic injury patients (age > 18 years) who were admitted within 24 h after corrosive ingestion were enrolled. All patients underwent CT and EGD within 48 h after the injury. The severity grading of both studies was collected and compared with the upper gastrointestinal barium study at 3 weeks post-injury, which was used for diagnosing caustic stricture. Patients were followed up until 6 months after injury. Receiver-operating characteristic values were constructed to evaluate the predictability of CT and EGD in diagnosing upper gastrointestinal tract strictures.

Twenty-three patients were enrolled between 1 September 2022 and 30 April 2023. Upper gastrointestinal tract stricture was detected in 5 of 12 patients (41%) who completed the follow-up period. The median time from injury to CT scan was 5 h, compared to 18 h for EGD. CT severity grading score of ≥ IIb resulted in 80% sensitivity and 86% specificity. Meanwhile, EGD with a Zagar severity classification of ≥ 2B resulted in 80% sensitivity and 71% specificity to predict stricture. The area under the receiver operating characteristic (AUROC) curve for CT in predicting caustic stricture was similar to that of EGD (0.97 vs. 0.91, p = 0.55).

The AUROC of CT and EGD was comparable. However, CT has a shorter timeframe, minimizes complications, avoids unnecessary surgery, and is more accessible. Therefore, CT can be considered an alternative method for predicting stricture in corrosive ingestion.