Foregut caustic injuries: results of the world society of emergency surgery consensus conference

Abstract

IntroductionLesions of the upper digestive tract due to ingestion of caustic agents still represent a major medical and surgical emergency worldwide. The work-up of these patients is poorly defined and no clear therapeutic guidelines are available.Purpose of the studyThe aim of this study was to provide an evidence-based international consensus on primary and secondary prevention, diagnosis, staging, and treatment of this life-threatening and potentially disabling condition.MethodsAn extensive literature search was performed by an international panel of experts under the auspices of the World Society of Emergency Surgery (WSES). The level of evidence of the screened publications was graded using the Oxford 2011 criteria. The level of evidence of the literature and the main topics regarding foregut caustic injuries were discussed during a dedicated meeting in Milan, Italy (April 2015), and during the 3rd Annual Congress of the World Society of Emergency Surgery in Jerusalem, Israel (July 2015).ResultsOne-hundred-forty-seven full papers which addressed the relevant clinical questions of the research were admitted to the consensus conference. There was an unanimous consensus on the fact that the current literature on foregut caustic injuries lacks homogeneous classification systems and prospective methodology. Moreover, the non-standardized definition of technical and clinical success precludes any accurate comparison of therapeutic modalities. Key recommendations and algorithms based on expert opinions, retrospective studies and literature reviews were proposed and approved during the final consensus conference. The clinical practice guidelines resulting from the consensus conference were approved by the WSES council.ConclusionsThe recommendations emerging from this consensus conference, although based on a low level of evidence, have important clinical implications. A world registry of foregut caustic injuries could be useful to collect a homogeneous data-base for prospective clinical studies that may help improving the current clinical practice guidelines.

Caustic ingestion: Has the role of the gastroenterologist burnt out?

“…In their 2014 review, Bonnici et al offered that while the current data does not support replacing endoscopy with CT, it is useful as an adjunct. In 2015, the World Society of Emergency Surgery consensus conference introduced emergency CT as routine in assessment of corrosive ingestions.…”

“…On presentation to the ED, local poison information centres are often the first to provide advice, and in keeping with worldwide practice, endoscopy within 6 h is commonly recommended . Symptoms do not always correlate with the extent of injury, so even in the asymptomatic or mildly symptomatic patient endoscopy is often considered part of routine assessment.…”

“…On presentation to the ED, local poison information centres are often the first to provide advice, and in keeping with worldwide practice, endoscopy within 6 h is commonly recommended. 2 Symptoms do not always correlate with the extent of injury, 3 so even in the asymptomatic or mildly symptomatic patient endoscopy is often considered part of routine assessment. Based on expert opinion, the ideal timing of endoscopy is within 24 h; beyond 24-48 h submucosal haemorrhages and oedema make interpretation of the true extent of injury difficult.…”

Nursing Care in Corrosive Esophageal Injuries in Children

“…Koroziv özofagus yaralanmalarında hemşirelik yönetimi; hastane öncesi (olay yeri) bakım, acil serviste bakım, erken (akut) dönem bakım, geç (kronik) dönem bakım ve rehabilitasyon (evde bakım) döneminde bakım olmak üzere beş bölümde incelenebilir (Tablo 1). 3…”

Esophageal tissue engineering

“…L'oesophagectomie peut être réalisée à distance souvent motivée par des sténoses oesophagiennes étendues [9].…”