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Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2018; 10(10): 274-282
Published online Oct 16, 2018. doi: 10.4253/wjge.v10.i10.274
Role of endoscopy in caustic injury of the esophagus
Asada Methasate, Varut Lohsiriwat
Asada Methasate, Varut Lohsiriwat, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Author contributions: Methasate A reviewed the literature and wrote the manuscript; Lohsiriwat V outlined the content and critically reviewed the manuscript.
Conflict-of-interest statement: The authors declared that we had no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Varut Lohsiriwat, MD, PhD, Associate Professor, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang-Lung Road, Bangkok 10700, Thailand. bolloon@hotmail.com
Telephone: +662-4198005 Fax: +662-4121370
Received: April 30, 2018
Peer-review started: April 30, 2018
First decision: May 15, 2018
Revised: June 6, 2018
Accepted: June 28, 2018
Article in press: June 29, 2018
Published online: October 16, 2018
Processing time: 170 Days and 20.2 Hours
Abstract

Caustic injury of the esophagus is a problematic condition challenging endoscopists worldwide. Although the caustic agents and motives are different among countries and age groups, endoscopy still plays an invaluable role in diagnosis and treatment. Endoscopy can determine the severity of caustic ingestion which is of great importance in choosing appropriate treatment. However, some aspects of endoscopy in diagnosis of caustic injury remain controversial. Whether or not all patients need endoscopy, when to perform endoscopy and how to assess the severity are just some examples of these controversies. Due to lack of randomized controlled trials, many findings and suggestions are inconclusive. Computerized tomography scan of the chest and abdomen gains popularity in assessing the severity of caustic injury and avoiding unnecessary surgery. If esophageal stricture eventually develops, endoscopic dilatation is a mainstay. Maneuvers such as steroid injection and esophageal stent may be used in a refractory stricture. Nevertheless, some patients have to undergo surgery in spite of vigorous attempts with esophageal dilatation. To date, caustic injury remains a difficult situation. This article reviews all aspects of caustic injury of the esophagus focusing on endoscopic role. Pre-endoscopic management, endoscopy and its technique in acute and late phase of caustic injury including the endoscopic management of refractory stricture, and the treatment outcomes following each endoscopic intervention are thoroughly discussed. Finally, the role of endoscopy in the long term follow-up of patients with esophageal caustic injury is addressed.

Keywords: Endoscopy; Diagnosis; Corrosive ingestion; Caustic injury; Esophagus; Stricture

Core tip: This mini-review comprehensively covered evidence-based endoscopy for caustic injury of the esophagus including pre-endoscopic management, endoscopic role in the acute and late phase of caustic injury, endoscopic management of refractory stricture and its outcomes. Tips and tricks to perform diagnostic and therapeutic endoscopy in these patients are also discussed.