TY  - JOUR
PY  - 2015//
TI  - Computed tomography evaluation of esophagogastric necrosis after caustic ingestion
JO  - Annals of surgery
A1  - Chirica, Mircéa
A1  - Resche-Rigon, Matthieu
A1  - Zagdanski, Anne Marie
A1  - Bruzzi, Matthieu
A1  - Bouda, Damien
A1  - Roland, Eric
A1  - Sabatier, François
A1  - Bouhidel, Fatiha
A1  - Bonnet, Francine
A1  - Munoz-Bongrand, Nicolas
A1  - Marc Gornet, Jean
A1  - Sarfati, Emile
A1  - Cattan, Pierre
SP  - 107
EP  - 113
VL  - 264
IS  - 1
N2  - BACKGROUND: Endoscopy is the standard of care for emergency patient evaluation after caustic ingestion. However, the inaccuracy of endoscopy in determining the depth of intramural necrosis may lead to inappropriate decision-making with devastating consequences. Our aim was to evaluate the use of computed tomography (CT) for the emergency diagnostic workup of patients with caustic injuries. <br><br>METHODS: In a prospective study, we used a combined endoscopy-CT decision-making algorithm. The primary outcome was pathology-confirmed digestive necrosis. The respective utility of CT and endoscopy in the decision-making process were compared. Transmural endoscopic necrosis was defined as grade 3b injuries; signs of transmural CT necrosis included absence of postcontrast gastric/ esophageal-wall enhancement, esophageal-wall blurring, and periesophageal-fat blurring. <br><br>RESULTS: We included 120 patients (59 men, median age 44 years). Emergency surgery was performed in 24 patients (20%) and digestive resection was completed in 16. Three patients (3%) died and 28 patients (23%) experienced complications. Pathology revealed transmural necrosis in 9/11 esophagectomy and 16/16 gastrectomy specimens. Severe oropharyngeal injuries (P = 0.015), increased levels of blood lactate (P = 0.007), alanine aminotransferase (P = 0.027), bilirubin (P = 0.005), and low platelet counts (P > 0.0001) were predictive of digestive necrosis. Decision-making relying on CT alone or on a combined CT-endoscopy algorithm was similar and would have spared 19 unnecessary esophagectomies and 16 explorative laparotomies compared with an endoscopy-alone algorithm. Endoscopy did never rectify a wrong CT decision. <br><br>CONCLUSIONS: Emergency decision-making after caustic injuries can rely on CT alone.<p />  <p>Language: en</p>
LA  - en
SN  - 0003-4932
UR  - http://dx.doi.org/10.1097/SLA.0000000000001459
ID  - ref1
ER  -