Abstract
Background
Both observational and aggressive surgical strategies have been advocated for the treatment of corrosive injuries of the upper gastrointestinal tract (UGT) but the optimal management is still a dilemma. The aim of this study was to report our experience with caustic UGT injuries in adult patients treated with a surgically aggressive, endoscopy-based therapeutic protocol over a 6-year period.
Patients and methods
Between January 2002 and December 2007, 315 patients (138 men, mean age = 40 ± 15.5 years) were referred for corrosive UGT injuries. Emergency endoscopy was performed in all patients at admission. Patients with mild injuries (grades I–IIIa) were offered nonoperative management, whereas emergency surgery was performed for severe injuries (grades IIIb and IV). Esophageal reconstruction was offered to psychologically stable patients after emergency esophageal resection and for esophageal strictures that failed endoscopic dilation. Functional failure was defined as the impossibility to remove the jejunostomy or/and the tracheotomy tube.
Results
At endoscopy 73 (23%) patients did not have UGT injuries, 158 (50%) patients had mild injuries eligible for nonoperative management and 84 (27%) patients had severe injuries. Nonoperative management was successful in 93% of patients with mild injuries. Surgical exploration was eventually performed in 88 (28%) patients and resection was undertaken in 76 of them. Emergency mortality was 7% and all fatalities were patients with initial severe injuries. After a median follow-up of 6 days (range = 1 day–8.5 years), functional failure was recorded in 9 (3%) patients, all of whom had initial severe injuries.
Conclusion
Emergency endoscopic grading of caustic injuries is the main factor that conditions outcome after caustic ingestion.
Similar content being viewed by others
References
Celerier M (1996) Management of caustic esophagitis in adults. Ann Chir 50:449–455
Andreoni B, Marini A, Gavinelli M, Biffi R, Tiberio G, Farina ML, Rossi A (1995) Emergency management of caustic ingestion in adults. Surg Today 25:119–124
Ertekin C, Alimoglu O, Akyildiz H, Guloglu R, Taviloglu K (2004) The results of caustic ingestions. Hepatogastroenterology 51:1397–1400
Hendrickx L, Hubens A, Van Hee W (1990) Emergency oesophageal stripping, an aggressive approach to acute, necrotic caustic burns of the oesophagus and stomach. Acta Chir Belg 90:46–49
Kirsh MM, Peterson A, Brown JW, Orringer MB, Ritter F, Sloan H (1978) Treatment of caustic injuries of the esophagus: a ten year experience. Ann Surg 188:675–678
Sarfati E, Gossot D, Assens P, Celerier M (1987) Management of caustic ingestion in adults. Br J Surg 74:146–148
Sarfati E, Jacob L, Servant JM, d’Acremont B, Roland E, Ghidalia T, Celerier M (1992) Tracheobronchial necrosis after caustic ingestion. J Thorac Cardiovasc Surg 103:412–413
Zargar SA, Kochhar R, Mehta S, Mehta SK (1991) The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc 37:165–169
Zargar SA, Kochhar R, Nagi B, Mehta S, Mehta SK (1989) Ingestion of corrosive acids. Spectrum of injury to upper gastrointestinal tract and natural history. Gastroenterology 97:702–707
Chirica M, de Chaisemartin C, Goasguen N, Munoz-Bongrand N, Zohar S, Cattan P, Brette MD, Sarfati E (2007) Colopharyngoplasty for the treatment of severe pharyngoesophageal caustic injuries: an audit of 58 patients. Ann Surg 246:721–727
Gago O, Ritter FN, Martel W, Orvald TO, Delavan JW, Dieterle RV, Kirsh MM, Kahn DR, Sloan H (1972) Aggressive surgical treatment for caustic injury of the esophagus and stomach. Ann Thorac Surg 13:243–250
Celerier M (2001) Caustic lesions of the esophagus in adults. Ann Chir 126:945–949
Di Costanzo J, Noirclerc M, Jouglard J, Escoffier JM, Cano N, Martin J, Gauthier A (1980) New therapeutic approach to corrosive burns of the upper gastrointestinal tract. Gut 21:370–375
Cheng HT, Cheng CL, Lin CH, Tang JH, Chu YY, Liu NJ, Chen PC (2008) Caustic ingestion in adults: the role of endoscopic classification in predicting outcome. BMC Gastroenterol 8:31
Mamede RC, de Mello Filho FV (2001) Ingestion of caustic substances and its complications. Sao Paulo Med J 119:10–15
Bothereau H, Munoz-Bongrand N, Lambert B, Montemagno S, Cattan P, Sarfati E (2007) Esophageal reconstruction after caustic injury: is there still a place for right coloplasty? Am J Surg 193:660–664
Chirica M, Veyrie N, Munoz-Bongrand N, Zohar S, Halimi B, Celerier M, Cattan P, Sarfati E (2010) Late morbidity after colon interposition for corrosive esophageal injury: risk factors, management, and outcome. A 20-years experience. Ann Surg 252:271–280
Keh SM, Onyekwelu N, McManus K, McGuigan J (2006) Corrosive injury to upper gastrointestinal tract: still a major surgical dilemma. World J Gastroenterol 12:5223–5228
Cattan P, Munoz-Bongrand N, Berney T, Halimi B, Sarfati E, Celerier M (2000) Extensive abdominal surgery after caustic ingestion. Ann Surg 231:519–523
Estrera A, Taylor W, Mills LJ, Platt MR (1986) Corrosive burns of the esophagus and stomach: a recommendation for an aggressive surgical approach. Ann Thorac Surg 41:276–283
Gumaste VV, Dave PB (1992) Ingestion of corrosive substances by adults. Am J Gastroenterol 87:1–5
Wu MH, Lai WW (1992) Esophageal reconstruction for esophageal strictures or resection after corrosive injury. Ann Thorac Surg 53:798–802
Tohda G, Sugawa C, Gayer C, Chino A, McGuire TW, Lucas CE (2008) Clinical evaluation and management of caustic injury in the upper gastrointestinal tract in 95 adult patients in an urban medical center. Surg Endosc 22:1119–1125
Hugh TB, Kelly MD (1999) Corrosive ingestion and the surgeon. J Am Coll Surg 189:508–522
Landen S, Wu MH, Jeng LB, Delugeau V, Launois B (2000) Pancreaticoduodenal necrosis due to caustic burns. Acta Chir Belg 100:205–209
Ramasamy K, Gumaste VV (2003) Corrosive ingestion in adults. J Clin Gastroenterol 37:119–124
Wu MH, Tseng YT, Lin MY, Lai WW (2001) Esophageal reconstruction for hypopharyngoesophageal strictures after corrosive injury. Eur J Cardiothorac Surg 19:400–405
Nunez O, Gonzalez-Asanza C, de la Cruz G, Clemente G, Banares R, Cos E, Menchen P (2004) Study of predictive factors of severe digestive lesions due to caustics ingestion. Med Clin (Barc) 123:611–614
Gault V, Cabral C, Duclos J, Resche-Rigon M, De Bazelaire C, Loiseaux F, Munoz-Bongrand N, Sarfati E, Zagdanski A, Cattan P (2008) Intérêt de la tomodensitométrie dans la prise en charge des brûlures caustiques sévères de l’œsophage. J Chir (Paris) 145:9
Kirsh MM, Ritter F (1976) Caustic ingestion and subsequent damage to the oropharyngeal and digestive passages. Ann Thorac Surg 21:74–82
Disclosure
Drs. Cabral, Chirica, de Chaisemartin, Gornet, Munoz-Bongrand, Halimi, Sarfati, and Cattan have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cabral, C., Chirica, M., de Chaisemartin, C. et al. Caustic injuries of the upper digestive tract: a population observational study. Surg Endosc 26, 214–221 (2012). https://doi.org/10.1007/s00464-011-1857-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-011-1857-0