Kochhar Rakesh, Ashat Munish, Reddy Yalaka Rami, Dhaka Narender, Manrai Manish, Sinha Saroj K, Dutta Usha, Yadav Thakur D, Gupta Vikas
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA.
Endoscopy. 2017 Jul;49(7):643-650. doi: 10.1055/s-0043-104857. Epub 2017 May 4.
Early ( < 24 hours) esophagogastroduodenoscopy (EGD) is used to prognosticate mucosal injury after caustic ingestion. We aimed to compare differences in endoscopic grading on EGDs performed on day 5 and day 1 and to assess the impact of relook endoscopy findings on the development of esophageal and/or antropyloric cicatrization. Consecutive patients admitted within 24 hours of caustic ingestion between 2009 and 2014 underwent EGD and had their mucosal changes graded. Injuries of grade ≤ 2a were classified as mild and ≥ 2b were classified as severe. Patients were followed up for the development of cicatrization and managed per protocol. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) were calculated to compare day 1 and day 5 EGD findings. A total of 62 patients (35 men; mean age 33 ± 15) underwent both day 1 and day 5 EGDs. Antropyloric stenosis developed in 16 patients, esophageal strictures in nine, and four had both esophageal and antropyloric strictures. Compared with day 1 EGD, endoscopic grading of severe injury on day 5 had higher specificity (83 % vs. 65 %), higher PPV (60 % vs. 41 %), and higher positive LR (5.65 vs. 2.66) for predicting the development of esophageal stricture. Similarly, day 5 endoscopic grading had higher specificity (95 % vs. 61 %), higher PPV (88 % vs. 54 %), and higher positive LR (16 vs. 2.5) for predicting the development of antropyloric stenosis. Endoscopic assessment on day 5 is a better predictor of esophageal and gastric cicatrization than day 1 EGD, which significantly overestimates the grade of injury.
早期（<24小时）食管胃十二指肠镜检查（EGD）用于预测腐蚀性物质摄入后的黏膜损伤。我们旨在比较第5天和第1天进行的EGD内镜分级差异，并评估再次内镜检查结果对食管和/或幽门瘢痕形成的影响。2009年至2014年间，在腐蚀性物质摄入后24小时内入院的连续患者接受了EGD检查，并对其黏膜变化进行了分级。≤2a级损伤分类为轻度，≥2b级损伤分类为重度。对患者进行瘢痕形成情况的随访，并按照方案进行处理。计算敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和似然比（LR），以比较第1天和第5天的EGD检查结果。共有62例患者（35例男性；平均年龄33±15岁）接受了第1天和第5天的EGD检查。16例患者发生幽门狭窄，9例发生食管狭窄，4例同时存在食管和幽门狭窄。与第1天的EGD相比，第5天严重损伤的内镜分级对于预测食管狭窄的发生具有更高的特异性（83%对65%）、更高的PPV（60%对41%）和更高的阳性LR（5.65对2.66）。同样，第5天的内镜分级对于预测幽门狭窄的发生具有更高的特异性（95%对61%）、更高的PPV（88%对54%）和更高的阳性LR（16对2.5）。与第1天的EGD相比，第5天的内镜评估是食管和胃瘢痕形成更好的预测指标，第1天的EGD显著高估了损伤分级。
