Answer
Endoscopy is generally indicated for the following patients:
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Small children who are not tolerating liquids or with complaints of pain
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Patients with a disk battery ingestion identified in the esophagus or stomach
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Symptomatic older children and adults
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Patients with abnormal mental status
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Patients with intentional ingestions
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Patients in whom injury is suspected for other reasons (eg, ingestion of large volumes or concentrated products)
However, because of the risk of increased injury, esophagoscopy should not be performed in patients with evidence of esophageal or gastrointestinal perforation, significant airway edema, or necrosis and in those who are hemodynamically unstable. Endoscopy is typically avoided when more than 24 hours have elapsed after the ingestion due to decreased wound strength and an increased risk of iatrogenic perforation.
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Media Gallery
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Caustic ingestions. Endoscopic view of the esophagus in a patient who ingested hydrochloric acid (Lime-a-way). Note the extensive thrombosis of the esophageal submucosal vessels giving the appearance similar to chicken wire. Courtesy of Ferdinando L. Mirarchi, DO, Fred P. Harchelroad Jr, MD, Sangeeta Gulati, MD, and George J. Brodmerkel Jr, MD.
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Caustic ingestions. Endoscopic view of the esophagus in a patient who ingested hydrochloric acid (Lime-a-way). Note the appearance of the thrombosed esophageal submucosal vessels giving the appearance of chicken wire. Courtesy of Ferdinando L. Mirarchi, DO, Fred P. Harchelroad Jr, MD, Sangeeta Gulati, MD, and George J. Brodmerkel Jr, MD.
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Caustic ingestions. Endoscopic view of the esophagus in a patient who ingested hydrochloric acid (Lime-a-way). Note the extensive burn and thrombosis of the submucosal esophageal vessels, which gives the appearance of chicken wire. Courtesy of Ferdinando L. Mirarchi, DO, Fred P. Harchelroad Jr, MD, Sangeeta Gulati, MD, and George J. Brodmerkel Jr, MD.
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Algorithm for the diagnosis and management of caustic ingestions. In all cases of caustic ingestion, the airway should be assessed initially and protected if necessary. If endoscopy is not rapidly available and severe injury is strongly suspected, obtain a contrast-enhanced computed tomographic (CT) study. The Usta protocol consists of methylprednisolone (1 g per 1.73 m2 of body-surface area per day, given intravenously for 3 days) plus ranitidine (4 mg per kilogram of body weight per day in children or the standard adult dose in adults, given intravenously) plus ceftriaxone (100 mg per kilogram per day in children or the standard adult dose in adults, given intravenously). NPO denotes nothing by mouth, and TPN total parenteral nutrition.
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