Is Diagnostic Endoscopy Necessary in All Caustic Ingestion in Children?

Caustic ingestion can result in severe gastrointestinal tract burns and important complications such as esophageal stricture. early diagnostic endoscopy is usually recommended routinely in all children after caustic ingestion. The aim of this study was to determine the predictive value of clinical symptoms and ingested material types and quantity as markers of severe esophagogastric lesions and eventual complications. 72 children were admitted after accidental caustic ingestion. The clinical symptoms; ingested product type and quantities, endoscopic data and outcome were prospectively analyzed. 36 patients had no symptoms (group B), others presented with one or more early symptoms (vomiting, hematemesis, drooling, respiratory distress) and/or oropharyngeal burns (group A). In group A, stronger substances were ingested in higher quantities. In group B, 23 patients ingested ‹20cc and 13 patients |"|20cc and in group A, one patient ‹20cc and 35 patients ingested |"|20cc. The proportion between patients who ingested ›20cc was 2.7 more in group A to B (35/13=2.7). In group A the relationship between the amount of the caustic agent and degree of GI damage was pvalue=0.036, but it was pvalue=0.492 in group B. Severe GI injuries in endosocpy were seen in 32 cases (77.8%), and 17 of them developed complications (47.2%). 3 patients had esophageal perforation in acute phase, in one case of them perforation was in both esophageal and gastric. 17 patients had stenosis (16 cases had esophageal stenosis and one case was associated with gastric inlet obstruction and in another one with esophago-pleural fistula) and one case had gastric outlet obstruction. In group B no severe burn and complication were seen. Between substance property and quantity, early symptoms with GI burn and complication was coherence (p‹0.05). In conclusion, diagnostic endoscopy is not necessary in asymptomatic children after accidental caustic ingestion.