[Endoscopic and Therapeutic Profile of Pediatric Patients with Caustic Ingestion: A Seven-Year Experience at a High-Complexity Pediatric Hospital]

Ingestion of caustic substances in children can cause esophagogastric injuries with significant sequelae, particularly esophageal stenosis. Early upper gastrointestinal endoscopy allows for grading the injury according to the Zargar endoscopic classification and guiding follow-up.

To describe the endoscopic and therapeutic profile of pediatric patients who ingested caustic substances and were treated between 2018 and 2024 at a referral pediatric hospital.

Observational, retrospective, and descriptive study. Patients under 14 years of age who underwent emergency upper gastrointestinal videoendoscopy due to suspected or clinically confirmed ingestion of caustic substances (January 2018 - December 2024) were included. Lesions were classified according to the Zargar endoscopic classification (0, I, IIa, IIb, III). Gastric involvement and the need for treatment (dilations, intralesional triamcinolone injection, or surgery) were recorded.

A total of 161 patients were analyzed (mean age 3 years; 65.8% male). At the initial endoscopy, no lesions were detected in 60 patients (37.3%); Zargar I was observed in 39 (24.2%), Zargar II in 53 (32.9%), and Zargar III in 9 (5.6%). Gastritis was noted in 25 cases (15.5%), mainly in Zargar II-III lesions. Esophageal dilations were required in 32 patients (19.8%): 25/53 (47.2%) with Zargar II lesions and 7/9 (77.8%) with Zargar III lesions. Five patients (3.1%) were identified with refractory stenosis (intervals ≤ 21 days). Fifteen patients received intralesional triamcinolone, although no conclusive benefit was observed in reducing the number of dilations. Two patients (1.2%) required surgical treatment (gastric ascension).

In this series, Zargar II lesions were the most common among significant lesions and were associated with a significant proportion of dilations. Early endoscopic stratification allows for the anticipation of the need for intervention and follow-up. In our experience, intralesional triamcinolone did not show a conclusive benefit.