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Introduction: Esophagogastroduodenoscopy (EGD) is currently considered as the primary method of determining the degree of mucosal injury following caustic ingestion. The present study aimed to evaluate the screening performance characteristics of EGD in predicting the depth of gastrointestinal mucosal injuries following caustic ingestion. Methods: Adult patients who were referred to emergency department due to ingestion of corrosive materials, over a 7-year period, were enrolled to this diagnostic accuracy study. Sensitivity, specificity, positive and negative predictive values as well as negative and positive likelihood ratios of EGD in predicting the depth of mucosal injury was calculated using pathologic findings as the gold standard. Results: 54 cases with the mean age of 35 ± 11.2 years were enrolled (59.25% male). Primary endoscopic results defined 28 (51.85%) cases as second grade and 26 (48.14%) as third grade of mucosal injury. On the other hand, pathologic findings reported 21 (38.88%) patients as first grade, 14 (25.92%) as second, and 19 patients (35.18%) as third grade. Sensitivity and specificity of endoscopy for determining grade II tissue injury were 50.00 (23.04-76.96) and 47.50 (31.51-63.87), respectively. These measures were 100.00 (82.35-100) and 80.00 (63.06-91.56), respectively for grade III. Accuracy of EGD was 87.03% for grade III and 48.14% for grade II. Conclusion: Based on the findings of the present study, endoscopic grading of caustic related mucosal injury based on the Zargar’s classification has good accuracy in predicting grade III (87%) and fail accuracy in grade II injuries (48%). It seems that we should be cautious in planning treatment for these patients solely based on endoscopic results.Â

Introduction: Endoscopy is an invasive procedure and finding noninvasive alternative tools in detection of probable upper gastrointestinal (GI) tract injuries following caustic ingestion is an area of interest. The present study aimed to evaluate the screening performance characteristics of thoraco-abdominal computed tomography (CT) scan in this regard. Methods: This prospective cross sectional study was conducted on patients presenting to emergency department following acute caustic ingestion. The findings of CT scan and endoscopy regarding the presence of upper GI tract damage were compared and screening performance characteristics of CT scan were calculated using MedCalc software. Results: 34 patients with the mean age of 35.38±13.72 years were studied (58.8% male). The agreement rate between CT scan and endoscopy regarding the grade of esophageal and gastric injuries was moderate (K= 0.38; p = 0.001) and fair (K= 0.17; p = 0.038), respectively. The sensitivity and specificity of CT scan in detection of esophageal damage were 96.29) 79.11- 99.80) and 57.14 (20.23 - 88.19), respectively. These measures were 89.65 (71.50 - 97.28) and 40.00 (7.25 - 82.95), respectively for gastric damage. The area under the ROC curve of CT scan in detection of esophageal and gastric damages was 0.76 (95% CI: 0.52 – 1.00) and 0.64 (95% CI: 0.35 – 0.94), respectively. Conclusion: Based on the findings of the present study, CT scan could be considered as a sensitive tool in ruling out upper gastrointestinal mucosal injuries following acute caustic ingestions. However, the correlation between endoscopy and CT scan findings regarding the grading of injury is not high enough to eliminate the need for endoscopy.Â

Introduction: Caustic ingestions are among the most prevalent causes of toxic exposure. The present 10-year survey aimed to evaluate the epidemiologic features and outcomes of caustic ingestion cases presenting to emergency department. Methods: This is a retrospective cross-sectional study on patients who were admitted to a referral toxicology center during 2004 to 2014, following caustic ingestion. Baseline characteristics, presenting chief complaint, severity of mucosal injury, complications, imaging and laboratory findings as well as outcomes (need for ICU admission, need for surgery, mortality) were recorded, reviewing patients’ medical profile, and analyzed using SPSS 22. Results: 348 patients with mean age of 37.76 ± 17.62 years were studied (55.6% male). The mean amount of ingested caustic agent was 106.69 ± 100.24 mL (59.2 % intentional). Intentional ingestions (p < 0.0001), acidic substance (p = 0.054), and higher volume of ingestion (p = 0.021) were significantly associated with higher severity of mucosal damage. 28 (8%) cases had died, 53 (15.2%) were admitted to ICU, and 115 (33%) cases underwent surgery. Conclusion: It seems that, suicidal intention, higher grade of mucosal injury, higher volume of ingestion, lower level of consciousness, lower serum pH, and higher respiratory rate are among the most important predictors of need for ICU admission, need for surgery, and mortality.