Role of Emergent Endoscopic Evaluation for Corrosive Injuries: Should We Do It or Not?

Abstract

Background/aim: Although emergency endoscopic evaluation of patients presenting with corrosive ingestion may facilitate prognosis prediction, the role of early endoscopic evaluation remains unclear. Therefore, we aimed to select patients who required emergency endoscopic evaluation based on the initial admission information and to investigate the factors associated with Zargar grade ≥2b in patients with corrosive ingestion.

Patients and methods: We retrospectively reviewed patients with corrosive ingestion who visited the emergency department between 2010 and 2023. We investigated short- and long-term endoscopic outcomes after corrosive ingestion. Using logistic regression analysis, we investigated the factors associated with endoscopic mucosal damage of Zargar grade ≥2b.

Results: A total of 211 patients were enrolled. The most common reason for and type of corrosive ingestion were suicidal intent (n=138, 65.4%) and alkaline substrates (n=181, 85.5%), respectively. The median (interquartile range, IQR) of endoscopy time after admission was 455 min (235-890 min), and 92.9% (n=196) of patients underwent endoscopic evaluation within 48 h. At the initial endoscopic evaluation, 47.9% (n=101) of the patients had no mucosal injury. Stricture was observed in 2.4% (n=5) during the follow-up period, and three (1.4%) deaths occurred. In multivariate logistic analysis, bleeding events [odds ratio (OR)=12.2, 95% confidence interval (CI)=1.619-164.581, p=0.024] and leukocytosis (OR=2.9, 95%CI=1.138-7.331, p=0.023) were significant risk factors for Zargar grade ≥2b. However, the amount ingested was not revealed to be a risk factor for Zargar grade ≥2b.

Conclusion: Mucosal injury was mild in most patients admitted to the emergency department after corrosive ingestion, regardless of the amount ingested.

Keywords: Corrosive injury; Zargar’s classification; endoscopy; esophageal stricture.