Does esophagoscopy play a beneficial role during evaluation and treatment planning of corrosive esophageal injuries?

Introduction: Evaluation with esophagoscopy in 24-48 hours after corrosive esophageal injury is routinely performed as part of the treatment plan. While esophagoscopy may reveal the severity of injury, rarely does it have an effect on treatment planning and initial management is widely based on clinical findings. Material and methods: Records of 275 patients with corrosive esophageal injuries treated at our department between 1989 and 2013 were evaluated retrospectively looking for initial clinical findings, esophagoscopy reports, X-ray studies, early and late complications to reveal the role of esophagoscopy in treatment planning. Results: The mean age of the 39,3% female and 60,7% male patients was 30/12 years (range 4/12 ? 16) and 73% (n=201) of the patients were under three years-of-age. The ingested material was alkaline in 55% of cases, acid in 39% and not specifiable in 6%. Clinical findings recorded at admittance were vomiting in 62,5%, oral lesions in 61% and excessive salivation in 25%. Esophagoscopy was performed in all and within 48 hours in approx. 88% of cases and showed no injuries in 28,4%, Grade I injuries (according to Di Costanzo) in20,4%, Grade IIa in 26,5% and Grade IIb in 24,7%. There were no patients with Grade II injuries. The severity of injury did not show any significant change in respect to the causative agent whether acid or alkaline, but patients with vomiting, oral burns and excessive salivation showed a markedly higher rate of severe esophageal burns. An upper GI tract X-ray passage study was performed routinely in all patients at three weeks after ingestion. Only 48% of all patients showed up for this study and the respective findings are summarized in the table below: Upper GI passage results Esophagoscopy findings Normal Esophageal stenosis Gastric outlet stenosis GER Grade 0 100% (n=11) - - - Grade I 95% (n=20) - - 5% (n=1) Grade IIa 88% (n=42) 4% (n=2) 4% (n=2) 4% (n=2) Grade IIb 54% (n=28) 40% (n=21) 4% (n=2) 2% (n=1) Feeding was initiated immediately in patients with no burns on esophagoscopy and according to clinical findings and swallowing ability in patients with burns. 95% of all patienst have been fed within two days. Conclusion: The positive correlation between clinical findings and development of esophageal stenosis allows a rough prediction based solely on clinical findings. While severe burns are associated with a higher rate of stenosis, this can only be verified by X-ray studies. Feeding is commonly initiated evaluating the ability to swallow without any difficulty. Despite its low morbidity rate esophagoscopy means another stress for the patient, takes time of the medical staff and increases the costs, hence considering its quite limited predictive value in treatment planning its routine use is not easily justifiable