Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Clin Toxicol (Phila). 2010 Feb;48(2):137-42. doi: 10.3109/15563650903585929.
The aim of this study was to test the utility of our computed tomography (CT) grading system, compared with endoscopy, for association with the development of esophageal stricture in patients with caustic ingestion.
This retrospective case series involved 49 patients with caustic ingestion from 1998 to 2009. The degree of esophageal damage was graded using a scoring system based on the extent of esophageal wall edema and the damage in adjacent tissue as seen on thoracoabdominal CT scans. The presence of esophageal stricture was established by esophagography. Diagnostic performance was compared using receiver operating characteristic (ROC) analysis. Sensitivity and specificity were calculated for the grading system.
The CT grading score results showed that grade III was the most common injury (20 cases, 40.8%), followed by grade IV (14 cases, 28.6%), grade II (9 cases, 18.4%), and grade I (6 cases, 12.2%). In addition, damage to the esophagus was significantly correlated with esophageal stricture when the extent of damage approached grades III and IV (p < 0.001). The CT grading system for esophageal stricture resulted in a slightly larger area under the receiver operating characteristic curve (0.90) compared with endoscopic grading system (0.79). The sensitivity and specificity of CT grading system were moderately higher than those of endoscopic grading system.
Assessment of the degree of esophageal damage using CT, a noninvasive modality, in patients who visit the emergency department following caustic ingestion should be useful in estimating the occurrence of complications including esophageal stricture.
本研究旨在测试我们的 CT 分级系统与内镜相比在预测腐蚀性摄入患者食管狭窄发展方面的效用。
本回顾性病例系列研究纳入了 1998 年至 2009 年间的 49 例腐蚀性摄入患者。使用基于胸腹 CT 扫描所见食管壁水肿程度和相邻组织损伤的评分系统对食管损伤程度进行分级。通过食管造影确定食管狭窄的存在。使用接收者操作特征 (ROC) 分析比较诊断性能。计算分级系统的敏感性和特异性。
CT 分级评分结果显示，最常见的损伤为 III 级（20 例，40.8%），其次为 IV 级（14 例，28.6%）、II 级（9 例，18.4%）和 I 级（6 例，12.2%）。此外，当损伤程度接近 III 级和 IV 级时，食管损伤与食管狭窄显著相关（p < 0.001）。与内镜分级系统（0.79）相比，食管狭窄的 CT 分级系统的 ROC 曲线下面积略大（0.90）。CT 分级系统的敏感性和特异性略高于内镜分级系统。
在腐蚀性摄入后就诊于急诊科的患者中，使用非侵入性的 CT 评估食管损伤程度有助于估计包括食管狭窄在内的并发症的发生。
