What is the Utility of Selected Clinical and Endoscopic Parameters in Predicting the Risk of Death after Caustic Ingestion?

Rigo, Gianpiero; Camellini, L.; Azzolini, Francesco; Guazzetti, Stefano; Bedogni, Giorgio; Merighi, A.; Bellis, Lia; Scarcelli, A.; Manenti, F.

doi:10.1055/s-2002-23633

Cited by 61 publications

(58 citation statements)

References 7 publications

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“…Kaya et al and Chen et al reported that WBC count could not predict the severity of esophageal injury in these studies; however Hovanond et al stated that WBC count was an independent predictor for high-grade injury. The prognostic relevance of leukocytosis was suggested another report by Rigo et al [22]. They suggested that a WBC count ≥ 20.000 cells/m 3 should be considered a predictor of a poor outcome.…”

Section: Discussionmentioning

confidence: 90%

Neutrophil to Lymphocyte Ratio as a Predictor of Endoscopic Damage in Caustic Injuries

Uyar¹,

Kök²

2017

J Clinic Toxicol

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Context: The endoscopic degree of injuries is the main finding for further management of caustic ingestions. However, if endoscopy cannot be performed quickly, clinicians decide on treatment and follow-up goals according to the signs and symptoms of the patient. The aim of this study was to determine the association of white blood cells (WBC), C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) with the degree of caustic injury and to evaluate whether NLR is able to predict the severity of injuries. Materials and methods:A retrospective evaluation was made of a total of 190 patients with a mean age of 38.6 years. WBC, neutrophil, lymphocyte and CRP values and endoscopic findings of all patients at hospital admission were retrieved from hospital files. The association between WBC, NLR, CRP and endoscopic findings was evaluated.Results: Endoscopy was normal in 28 of 119 patients (23.5%) and most patients (42 of 119 (35.3%) had only gastric involvement. NLR was significantly higher in patients with injuries than normal patients (p=0.010), whereas WBC and CRP not. NLR was also significantly higher in patients with both esophagus and gastric injuries compared to patients with no organ involvement (p<0.001). NLR, WBC and CRP were weakly correlated to the grade of involvement. In the ROC analysis, the AUC value was 0.914 (95% CI (0.85-0.96, p<0.001)) and the cut-off value for NLR was 8.71 with sensitivity of 90% and specificity of 91.7% for discriminating injuries as grade 0-1-2 from 3-4. Conclusions:Higher NLR values showed widespread and severe involvement of caustic ingestion. NLR also seems to be a more reliable method to make a distinction between severe and mild injuries. It is an easily derived and inexpensive marker of inflammation and might guide the management of patients before endoscopic evaluation in emergency departments.

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Section: Discussionmentioning

confidence: 90%

Neutrophil to Lymphocyte Ratio as a Predictor of Endoscopic Damage in Caustic Injuries

Uyar¹,

Kök²

2017

J Clinic Toxicol

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“…According to previous studies, it was safe up to 96 hours after caustic ingestion, and even dilatation have been performed without consequences from 5 to 15 days after corrosive event. They also mentioned passage of the scope should be limited to the level of the first signs of a circumferential second or third degree esophageal injury to prevent possible adverse event [13,[19][20][21][22]. Besides, we thought gentle insufflation, delicate manipulation, great caution and carbon dioxide use might further improve the safety and decrease complications.…”

Section: Discussionmentioning

confidence: 99%

The Role of Second-look Endoscopy in Severe Esophageal Caustic Injury

Puo-Hsien¹,

Seak²,

Chiu³

et al. 2017

J Gastrointest Dig Syst

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Severe caustic ingestion often leads to multiple complications and high mortality rate. Esophagogastroduodenoscopy is recommended during the first 24 hours for severity and extent evaluation, but it seems insufficient to guide further managements in severe caustic injury patients due to rapid progression and variable clinical conditions. Therefore, we tried to evaluate the safety and role of second-look endoscopy in these patients in 1-2 weeks later.We retrospectively collected severe esophageal caustic injury (grade 2b, 3a, 3b) adults with and without secondlook endoscopy in subacute stage (6 th -14 th days after caustic injury) in Linkou Change Gung Memorial Hospital during 2011/1-2014/11. They were divided in to once endoscopy group and second-look endoscopic group according to the patients with second-look endoscopy or not. They were further matched with the same cause of caustic injury, corrosive properties, injury grading, and then selected with Excel RAND function. There were 26 patients in both groups.The average timing of second-look endoscopy was 10.23 ± 3.166 (mean ± SD) days after caustic ingestion. The hospital stay was significantly shorter in the second-look endoscopy group (24.92 ± 17.50 days, 54.38 ± 43.73 days, P=0.002). However, the complication rate was not statistically significant between these two groups.In conclusion, second-look endoscopy is safe and might shorten the hospital stay. However, prospective, randomized and larger sample size studies are needed to support the finding.

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“…Esophagogastroduodenoscopy is considered crucial and usually recommended in the first 12-48 hours after caustic ingestion, though it is safe and reliable up to 96 hours after the injury; gentle insufflation and great caution are mandatory during the procedure [4,12,[19][20][21]. Endoscopy and even dilatation have been performed without consequences from 5 to 15 days after corrosive ingestion; though potentially hazardous due to tissue softening and friability during the healing period.…”

Section: Investigationsmentioning

confidence: 99%

Corrosive Injury of the Upper Gastrointestinal Tract: A Review

Arunachalam¹,

Rammohan²

2016

Arch Clin Gastroenterol

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Ingestion of a corrosive substance can produce severe injury to the gastrointestinal tract and can even result in death. The degree and extent of damage depends on several factors like the type of substance, the morphologic form of the agent, the quantity, and the intent. In the acute stage, perforation and necrosis may occur. Long-term complications include stricture formation in the esophagus, antral stenosis and the development of esophageal carcinoma. Endoscopy should be attempted and can be safely performed in most cases to assess the extent of damage. Procedure related perforation is rare. Stricture formation is more common in patients with second and third degree burns. This review summarizes our current knowledge and evidence based management of this unique but not uncommon pathology of the upper gastrointestinal tract.

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What is the Utility of Selected Clinical and Endoscopic Parameters in Predicting the Risk of Death after Caustic Ingestion?

Abstract: Age, ingestion of a strong acid, leucocytosis, deep gastric ulcers, and gastric necrosis are predictive of death after caustic ingestion. A risk score system including these predictors may be useful in prognostic evaluation.

Cited by 61 publications

References 7 publications

Neutrophil to Lymphocyte Ratio as a Predictor of Endoscopic Damage in Caustic Injuries

Neutrophil to Lymphocyte Ratio as a Predictor of Endoscopic Damage in Caustic Injuries

The Role of Second-look Endoscopy in Severe Esophageal Caustic Injury

Corrosive Injury of the Upper Gastrointestinal Tract: A Review

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