Observational Study
Copyright ©The Author(s) 2024.
World J Gastrointest Pharmacol Ther. Nov 5, 2024; 15(6): 99097
Published online Nov 5, 2024. doi: 10.4292/wjgpt.v15.i6.99097
Table 1 Classification systems for endoscopic and computed tomography grading of acute corrosive injuries
Modified Zargar endoscopic grading[1]
    Grade 0Normal
    Grade IOedema and hyperaemia of mucosa
    Grade IIASuperficial localised ulcerations, friability and blisters
    Grade IIBCircumferential and deep ulcerations
    Grade IIIAMultiple and deep ulcerations and small, scattered areas of necrosis
    Grade IIIBExtensive necrosis
    Grade IVPerforation
CT grading[2]
    Grade 1Normal appearance
    Grade 2Wall and soft tissue oedema, increased wall enhancement
    Grade 3Transmural necrosis with absent wall enhancement (with or without perforation)
Table 2 Baseline demographics and details of the corrosive ingestion incident
Baseline demographics (n = 100)
n
%
Gender
Female3535.0
Male6565.0
Comorbidities
No6767.0
Yes3333.0
Specified comorbidities
Known psychiatric history1515.0
HIV positive1212.0
Hypertension22.0
Obesity33.0
Diabetes mellitus11.0
Other comorbidity77.0
Substance use
No5959.0
Yes4141.0
Substance use specified
Smoking3131.0
Alcohol - regular use2121.0
Marijuana1010.0
Methamphetamine88.0
Methaqualone77.0
Opioids11.0
Prior corrosive ingestion/suicide attempt
Yes1111.0
No8989.0
Corrosive ingestion incident (n = 100)
Intentional/accidental
Intentional (suicidal)7373.0
Accidental2020.0
Forced ingestion (assault)55.0
Unknown22.0
Substance ingested
Acid3232.0
Sulphuric acid22
Hydrochloric acid3
Other acid7
Alkali5858.0
Sodium hypochlorite (bleach)30
Sodium hydroxide27
Other alkali3
Other corrosive substance1010.0
Unknown corrosive substance55.0
Table 3 Imaging and endoscopy investigations performed on admission
Imaging/endoscopy during acute admission (n = 100)
n
%
n
%
n
%
Endoscopy9595.0
Chest X-ray8282.0
Lateral neck X-ray3131.0
CT1717.0
Contrast swallow11.0
None11.0
Endoscopy findings (n = 95)n%n%n%
OesophagusStomachDuodenum
Not entered11.133.23233.7
Zargar 02324.21414.74244.2
Zargar I1111.62526.399.5
Zargar IIA2021.11414.777.4
Zargar IIB2627.488.411.1
Zargar IIIA66.31616.811.1
Zargar IIIB88.41414.733.2
Zargar IV00.011.100.0
CT findings (n = 17)n%n%
OesophagusStomach
Grade 1 - normal211.8529.4
Grade 2 - oedematous only1164.7847.1
Grade 3 - lack of contrast enhancement
Without perforation317.6211.8
With perforation15.9211.8
Table 4 Overview of acute management
Management


Median (IQR) time from ingestion to first healthcare assessment6 (2-13) hours
Emergency resuscitationn%
Required emergency resuscitation2323.0
Specified
Endotracheal intubation1919.0
Chest compressions11.0
Inotropes33.0
Other122.0
Other management initiated in the emergency department
Proton pump inhibitor therapy3535.0
Prophylactic antibiotics77.0
Therapeutic antibiotics44.0
Nasogastric tube insertion (for drainage, not feeding)44.0
Activated charcoal administration44.0
Steroids11.0
Neutralizing agent00.0
Surgery
Required acute surgery2020.0
Decision for needing surgery (n = 20)
Based on endoscopy findings1365.0
Based on CT findings525.0
Based on clinical findings only210.0
Type of surgery (n = 20)
Emergency resection performed1155.0
    Oesophagectomy only1
    Oesophagogastrectomy5
    Gastrectomy only5
    Extended resections22
Exploration only - decision for palliation630.0
Feeding jejunostomy (only)15.0
Gastrojejunostomy & gastrostomy15.0
Negative laparotomy15.0
Table 5 Outcomes for 30-days post corrosive ingestion. Acute admission outcomes
Outcomes (n = 100)
n
%
30-day mortality1414.0
30-day morbidity2727.0
Required ICU management2626.0
Median (IQR) ICU stay2.5 (2-3.25) days
Median (IQR) length of hospital stay6 (2-15.5) days
Acute morbidities specified (n = 39)
Pneumonia (nosocomial)717.9
Acute kidney injury512.8
Cardiac arrest (unexpected)410.3
Refeeding syndrome37.7
Systemic sepsis25.1
Unplanned extubation25.1
Surgical site infection25.1
Other1435.9
Table 6 Multivariate analysis of numerous admission variables in predicting full thickness necrosis and short-term mortality, n (%)
Variables
Predicting full thickness necrosis
Predicting acute mortality


Total, n
No FT necrosis
FT necrosis
P value
ROC AUC
No mortality
Mortality
P value
ROC AUC
GenderFemale353188.6411.40.2792880.0720.00.207
Male65528013205889.2710.8
At least one comorbidityNo675886.6913.40.1785683.61116.40.323
Yes332575.8824.23090.939.1
Known psychiatric historyNo857183.51416.50.7397284.71315.30.377
Yes1512803201493.316.7
Known HIV positiveNo887585.21314.80.117484.11415.90.138
Yes12866.7433.312100.000.0
Prior corrosive/suicide attemptNo897584.31415.70.3397786.51213.50.673
Yes11872.7327.3981.8218.2
Needing endotracheal intubationNo827186.61113.40.0430.6046984.11315.90.257
Yes181266.7633.31794.415.6
Needing chest compressionsNo998383.81616.20.0270.5298585.91414.10.687
Yes10011001100.000.0
Needing inotropes/vasopressorsNo978183.51616.50.4478385.61414.40.480
Yes3266.7133.33100.000.0
≥ Zargar IIIB endoscopic findingsNo797594.945.1< 0.0010.857493.756.3< 0.0010.759
Yes164251275850.0850.0
Grade 3 CT FindingsNo121083.3216.70.0160.7881191.718.30.0260.798
Yes5120480240.0360.0
Age (years)10031 (24-38)39 (30-50)0.0150.68732 (24-40)31 (25-40)0.917
Systolic BP (mmHg)48134 (114-143)129 (113-149)0.926130 (113-144)134 (120-137)0.919
Diastolic BP (mmHg)4880 (73-90)83 (75-97)0.30982 (73-90)79 (64-91)0.520
Heart rate (beats per minute)4894 (79-109)86 (72-105)0.40593 (76-110)94 (82-107)0.965
Urea (mmol/L)794.6 (3.3-5.9)5.1 (2.7-7.1)0.6864.7 (3.2-6.5)3.9 (3.4-5.4)0.432
Creatinine (umol/L)8870 (57-81)84 (68-102)0.0380.66672 (58-85)72 (66-84)0.892
WCC (× 109/L)8514.07 (9.58-18.31)13.80 (9.76-19.16)0.69513.79 (9.59-18.31)15.75 (10.63-20.50)0.605
Platelets (× 109/L)81253 (210-326)206 (171-266)0.0450.666245 (194-308)263 (232-375)0.142
Calcium (mmol/L)122.21 (2.00-2.35)1.99 (199-1.99)0.312.15 (1.99-2.35)2.21 (2.21-2.21)0.885
pH417.37 (7.31-7.42)7.13 (7.07-7.35)0.0030.8237.35 (7.17-7.40)7.36 (7.27-7.43)0.593
Base excess (mEq/L)40-0.50 (-5.50-2.10)-14.20 (-17.00 to -4.60)0.0040.819-3.2 (-12.1-0.65)2.45 (-0.58-5.38)0.0200.199
Lactate (mmol/L)401.80 (1.20-3.30)3.20 (2.60-4.45)0.0260.7462.45 (1.20-3.55)1.55 (1.18-3.48)0.677
Ingestion to first assessment (hours)946.0 (2.5-14.5) 4.0 (2.0-8.5)0.2096.0 (3.0-15.5)3.0 (1.5-6.5)0.052
Table 7 Admission endoscopy, computed tomography and blood gas performance in predicting full thickness necrosis

Total
FT necrosis
Not FT necrosis
Sensitivity, %
Specificity, %
PPV, %
NPV, %
P value
ROC AUC
Endoscopy performance (n = 95)
Zargar IIIB1612475.094.975.094.5< 0.0010.850
CT performance (n = 17)
CT grade 354166.790.980.083.30.0260.788
Blood gas performance (n = 40)
pH < 7.352071377.858.135.090.00.0620.679
BE < -2 mEq/L1871177.864.538.990.90.0270.711
Lactate > 2.0 mmol/L2181388.958.138.194.70.0140.735
Blood gas performance (Patients with concomitant toxin ingestion removed) (n = 35)
pH < 7.351971277.858.135.0100.00.0070.786
BE < -2 mEq/L1771077.858.135.0100.00.0030.821
Lactate > 2.0 mmol/L1861277.858.135.094.10.0460.714