Journal article
Relook endoscopy predicts the development of esophageal and antropyloric stenosis better than immediate endoscopy in patients with caustic ingestion
Endoscopy, Vol.49(7), pp.643-650
07/2017
DOI: 10.1055/s-0043-104857
PMID: 28472833
Abstract
Early ( < 24 hours) esophagogastroduodenoscopy (EGD) is used to prognosticate mucosal injury after caustic ingestion. We aimed to compare differences in endoscopic grading on EGDs performed on day 5 and day 1 and to assess the impact of relook endoscopy findings on the development of esophageal and/or antropyloric cicatrization.
Consecutive patients admitted within 24 hours of caustic ingestion between 2009 and 2014 underwent EGD and had their mucosal changes graded. Injuries of grade ≤ 2a were classified as mild and ≥ 2b were classified as severe. Patients were followed up for the development of cicatrization and managed per protocol. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) were calculated to compare day 1 and day 5 EGD findings.
A total of 62 patients (35 men; mean age 33 ± 15) underwent both day 1 and day 5 EGDs. Antropyloric stenosis developed in 16 patients, esophageal strictures in nine, and four had both esophageal and antropyloric strictures. Compared with day 1 EGD, endoscopic grading of severe injury on day 5 had higher specificity (83 % vs. 65 %), higher PPV (60 % vs. 41 %), and higher positive LR (5.65 vs. 2.66) for predicting the development of esophageal stricture. Similarly, day 5 endoscopic grading had higher specificity (95 % vs. 61 %), higher PPV (88 % vs. 54 %), and higher positive LR (16 vs. 2.5) for predicting the development of antropyloric stenosis.
Endoscopic assessment on day 5 is a better predictor of esophageal and gastric cicatrization than day 1 EGD, which significantly overestimates the grade of injury.
Details
- Title: Subtitle
- Relook endoscopy predicts the development of esophageal and antropyloric stenosis better than immediate endoscopy in patients with caustic ingestion
- Creators
- Rakesh Kochhar - Post Graduate Institute of Medical Education and ResearchMunish Ashat - John H. Stroger, Jr. Hospital of Cook CountyYalaka Rami Reddy - Post Graduate Institute of Medical Education and ResearchNarender Dhaka - Post Graduate Institute of Medical Education and ResearchManish Manrai - Post Graduate Institute of Medical Education and ResearchSaroj K Sinha - Post Graduate Institute of Medical Education and ResearchUsha Dutta - Post Graduate Institute of Medical Education and ResearchThakur D Yadav - Post Graduate Institute of Medical Education and ResearchVikas Gupta - Post Graduate Institute of Medical Education and Research
- Resource Type
- Journal article
- Publication Details
- Endoscopy, Vol.49(7), pp.643-650
- DOI
- 10.1055/s-0043-104857
- PMID
- 28472833
- ISSN
- 0013-726X
- eISSN
- 1438-8812
- Language
- English
- Date published
- 07/2017
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984359855702771
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