Système gastro-intestinal et digestif

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

Le Puo-Hsien, Seak Chen-June, Chiu Cheng-Tang, Chen Tsung-Hsing, Kang Shih-Ching and Cheng Hao-Tsai

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 (6th-14th 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.