Emergency computed tomography evaluation of caustic ingestion

Author:

Assalino Michela1,Resche-Rigon Matthieu2,Corte Helene1,Maggiori Leon1,Zagdanski Anne Marie3,Goere Diane1,Sarfati Emile1,Cattan Pierre1,Chirica Mircea14

Affiliation:

1. Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital , Paris , France

2. Université de Paris, Department of Biomedical Statistics Saint-Louis Hospital , Paris , France

3. Department of Radiology, Saint-Louis Hospital , Paris , France

4. Department of Surgery, Centre Hospitalier Universitaire Grenoble Alpes , Grenoble , France

Abstract

Summary Computed tomography (CT) is used increasingly for the emergency assessment of caustic injuries and the need for emergency endoscopy has been challenged. The study evaluates outcomes of caustic ingestion in the modern era and the feasibility of abandoning emergency endoscopy. Between 2013 and 2019, 414 patients (197 men, median age 42 years) were admitted for caustic ingestion. Emergency and long-term outcomes of patients managed by CT and endoscopy (n = 120) and by CT alone (n = 294) were compared. Propensity score-based analysis was performed to limit bias of between-group comparison. A standard mortality ratio (SMR) was used to compare the observed mortality with the expected mortality in the general French population. Complications occurred in 97 (23%) patients and 17 (4.1%) patients died within 90 days of ingestion. Among 359 patients who underwent nonoperative management, 51 (14%) experienced complications and 7 (2%) died. Of 55 patients who underwent emergency surgery, 46 (84%) experienced complications and 10 (18%) died. The SMR was 8.4 for whole cohort, 5.5 after nonoperative management, and 19.3 after emergency surgery. On multivariate analysis, intentional ingestion (P < 0.016), age (P < 0.0001) and the CT grade of esophageal injuries (P < 0.0001) were independent predictors of survival. The CT grade of esophageal injuries was the only independent predictor of success (P < 0.0001). Crude and propensity match analysis showed similar survival in patients managed with and without endoscopy. CT evaluation alone can be safely used for the emergency management of caustic ingestion.

Publisher

Oxford University Press (OUP)

Subject

Gastroenterology,General Medicine

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