CAUSTIC INJURY TO THE UPPER GASTROINTESTINAL TRACT

THE ROLE OF FIBEROPTIC ENDOSCOPY

Abstract

During the past four years, 14 patients have been treated for ingestion of caustic materials, including acid in three patients, lye in five, bleach in three, ammonia in one and detergent in two. Each patient underwent fiberoptic endoscopic evaluation using a small caliber panendoscope. Sulfuric acid caused extensive partial thickness injury to the esophagus, stomach and duodenal bulb in one patient who had developed pyloric stenosis requiring hemigastrectomy 30 days later. Lye ingestion caused extensive mucosal inflammation of the esophagus, stomach and duodenum in three patients and severe injury to the oral pharynx and esophagus in the other patient. One patient had emergency total gastrectomy. Bleach ingestion caused moderate esophagitis, gastritis or duodenitis, and all patients were discharged within five days. Detergent caused moderate esophagitis and esophageal ulcer. Ammonia caused extensive mucosal inflammation of the oral pharynx, esophagus, stomach and duodenum. Both groups of patients were discharged in six days. The result of treatment in these patients shows that early panendoscopy after ingestion can be performed safely and provides an accurate guide for therapy. Subsequent panendoscopy on a weekly basis allows for continued rational observation or surgical intervention according to the endoscopic findings.