BACKGROUND: Both observational and aggressive surgical strategies have been advocated for the treatment of corrosive injuries of the upper gastrointestinal tract (UGT) but the optimal management is still a dilemma. The aim of this study was to report our experience with caustic UGT injuries in adult patients treated with a surgically aggressive, endoscopy-based therapeutic protocol over a 6-year period. PATIENTS AND METHODS: Between January 2002 and December 2007, 315 patients (138 men, mean age = 40 ± 15.5 years) were referred for corrosive UGT injuries. Emergency endoscopy was performed in all patients at admission. Patients with mild injuries (grades I-IIIa) were offered nonoperative management, whereas emergency surgery was performed for severe injuries (grades IIIb and IV). Esophageal reconstruction was offered to psychologically stable patients after emergency esophageal resection and for esophageal strictures that failed endoscopic dilation. Functional failure was defined as the impossibility to remove the jejunostomy or/and the tracheotomy tube. RESULTS: At endoscopy 73 (23%) patients did not have UGT injuries, 158 (50%) patients had mild injuries eligible for nonoperative management and 84 (27%) patients had severe injuries. Nonoperative management was successful in 93% of patients with mild injuries. Surgical exploration was eventually performed in 88 (28%) patients and resection was undertaken in 76 of them. Emergency mortality was 7% and all fatalities were patients with initial severe injuries. After a median follow-up of 6 days (range = 1 day-8.5 years), functional failure was recorded in 9 (3%) patients, all of whom had initial severe injuries. CONCLUSION: Emergency endoscopic grading of caustic injuries is the main factor that conditions outcome after caustic ingestion.
BACKGROUND: Both observational and aggressive surgical strategies have been advocated for the treatment of corrosive injuries of the upper gastrointestinal tract (UGT) but the optimal management is still a dilemma. The aim of this study was to report our experience with caustic UGT injuries in adult patients treated with a surgically aggressive, endoscopy-based therapeutic protocol over a 6-year period. PATIENTS AND METHODS: Between January 2002 and December 2007, 315 patients (138 men, mean age = 40 ± 15.5 years) were referred for corrosive UGT injuries. Emergency endoscopy was performed in all patients at admission. Patients with mild injuries (grades I-IIIa) were offered nonoperative management, whereas emergency surgery was performed for severe injuries (grades IIIb and IV). Esophageal reconstruction was offered to psychologically stable patients after emergency esophageal resection and for esophageal strictures that failed endoscopic dilation. Functional failure was defined as the impossibility to remove the jejunostomy or/and the tracheotomy tube. RESULTS: At endoscopy 73 (23%) patients did not have UGT injuries, 158 (50%) patients had mild injuries eligible for nonoperative management and 84 (27%) patients had severe injuries. Nonoperative management was successful in 93% of patients with mild injuries. Surgical exploration was eventually performed in 88 (28%) patients and resection was undertaken in 76 of them. Emergency mortality was 7% and all fatalities were patients with initial severe injuries. After a median follow-up of 6 days (range = 1 day-8.5 years), functional failure was recorded in 9 (3%) patients, all of whom had initial severe injuries. CONCLUSION: Emergency endoscopic grading of caustic injuries is the main factor that conditions outcome after caustic ingestion.
Authors: E Sarfati; L Jacob; J M Servant; B d'Acremont; E Roland; T Ghidalia; M Celerier Journal: J Thorac Cardiovasc Surg Date: 1992-03 Impact factor: 5.209
Authors: Mircea Chirica; Cécile de Chaisemartin; Nicolas Goasguen; Nicolas Munoz-Bongrand; Sarah Zohar; Pierre Cattan; Marie-Dominique Brette; Emile Sarfati Journal: Ann Surg Date: 2007-11 Impact factor: 12.969
Authors: Oscar Núñez; Cecilia González-Asanza; Gema de la Cruz; Gerardo Clemente; Rafael Bañares; Enrique Cos; Pedro Menchén Journal: Med Clin (Barc) Date: 2004-11-06 Impact factor: 1.725
Authors: Mircea Chirica; Matthieu Resche-Rigon; Benjamin Pariente; Fabienne Fieux; François Sabatier; Franck Loiseaux; Nicolas Munoz-Bongrand; Jean Marc Gornet; Marie-Dominique Brette; Emile Sarfati; Elie Azoulay; Anne Marie Zagdanski; Pierre Cattan Journal: Surg Endosc Date: 2014-08-27 Impact factor: 4.584
Authors: A Chibishev; Z Pereska; N Simonovska; V Chibisheva; M Glasnovic; L T Chitkushev Journal: J Gastrointest Surg Date: 2013-03-30 Impact factor: 3.452