Role of Endoscopic Ultrasound (EUS) in Predicting Stricture Formation Following Caustic Injury

Caustic ingestion remains a significant public health concern, particularly in low- and middle-income countries, and often results in long-term complications such as esophageal strictures. Esophagogastroduodenoscopy (EGD) is widely used for grading mucosal injury (Zargar classification) but cannot assess wall depth. Endoscopic ultrasound (EUS) allows visualization of transmural involvement, yet its prognostic role in caustic injuries is underexplored.

This prospective cohort study included 63 adults with confirmed caustic ingestion who underwent both EGD and EUS within 24 h. Zargar grades and EUS findings were recorded, and patients were followed for 12 weeks to assess stricture formation and clinical outcomes. Statistical comparisons were made between those who developed strictures and those who did not.

Median age was 25 years (interquartile range [IQR] 20-40), and 75% were female. Acid ingestion predominated (60%), and most cases (89%) were intentional. Strictures developed in 41% of patients, most frequently in the esophagus. Male sex was significantly associated with stricture formation (p = 0.015). All patients with Zargar grade IIIA/IIIB or muscularis/serosal involvement on EUS developed strictures, while none with Zargar I or mucosal-only involvement did. Dysphagia was the most common post-discharge symptom, reported by 40% at 12 weeks. No EUS-related complications occurred.

EUS appears promising in providing complementary prognostic information to EGD and may improve stricture risk stratification, particularly in intermediate- and high-grade injuries. Incorporating EUS into early evaluation could guide closer monitoring and intervention. Larger multicenter studies with longer follow-up are warranted.