Abbas A, Brar T S, Zori A, Estores D S
Department of Medicine.
Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA.
Dis Esophagus. 2017 Jun 1;30(6):1-11. doi: 10.1093/dote/dox010.
Caustic substance ingestion (CSI) is a serious medical problem with potentially devastating short- and long-term consequences. Early upper gastrointestinal endoscopy (EaEn) is recommended to evaluate the extent of injury and guide management but there has been controversy about the timing. There is no nationwide study evaluating adherence to EaEn and outcomes following CSI.Nationwide Inpatient Sample database 2003-2011 was used to identify all-age, nonreferral, urgent/emergent admissions with E-International Classification of Diseases Ninth Revision codes for CSI. We evaluated the association of undergoing late endoscopy (LaEn, >48 hours since admission) with poor clinical (death or systemic complications) and economic (cost for admission and length of stay above the 75th percentile) outcomes after controlling for other demographic and clinical factors using a multivariate analysis.We identified 21,682 patients with a median age of 37 years, 51% males, 43% Caucasians, with suicidal ingestion reported in 40%. Endoscopy was performed in 6011 patients (37%). The majority had EaEn (43% within 24, and 40% within 24-48 hours), whereas 17% had LaEn.Compared to EaEn group, the LaEn group was associated with a three-fold increase (OR = 2.7, P < 0.001) in the risk for poor clinical outcome: a fourfold increase (OR = 4.6, P < 0.001) in high cost admissions, and a fivefold increase (OR = 4.9, P < 0.001) in prolonged hospitalization. There was no significant difference in clinical outcomes based on endoscopy within 24, and 24-48 hours of admission.In this retrospective nationwide database analysis, undergoing LaEn was associated with both negative clinical and economic outcomes. More studies are needed to further examine the reasons for delaying endoscopy and subsequent management pathways based on the endoscopic findings. Early endoscopic evaluation could potentially improve the clinical outcomes and reduce costs of these admissions.
腐蚀性物质摄入（CSI）是一个严重的医学问题，可能会产生毁灭性的短期和长期后果。建议早期进行上消化道内镜检查（EaEn）以评估损伤程度并指导治疗，但关于检查时机一直存在争议。目前尚无全国性研究评估CSI患者接受EaEn的依从性及其预后情况。
利用2003 - 2011年全国住院患者样本数据库，通过国际疾病分类第九版编码识别所有年龄段、非转诊、急诊入院的CSI患者。在控制了其他人口统计学和临床因素后，我们使用多变量分析评估了接受延迟内镜检查（LaEn，入院后>48小时）与不良临床结局（死亡或全身并发症）和经济结局（入院费用和住院时间高于第75百分位数）之间的关联。
我们共识别出21,682例患者，中位年龄为37岁，男性占51%，白种人占43%，40%的患者有自杀性摄入史。6011例患者（37%）接受了内镜检查。大多数患者接受了EaEn（43%在24小时内，40%在24 - 48小时内），而17%的患者接受了LaEn。
与EaEn组相比，LaEn组不良临床结局风险增加了两倍（OR = 2.7，P < 0.001）：高费用入院风险增加了四倍（OR = 4.6，P < 0.001），住院时间延长风险增加了五倍（OR = 4.9，P < 0.001）。入院后24小时内和24 - 48小时内进行内镜检查的患者临床结局无显著差异。
在这项全国性回顾性数据库分析中，接受LaEn与不良临床和经济结局均相关。需要更多研究进一步探讨内镜检查延迟的原因以及基于内镜检查结果的后续治疗途径。早期内镜评估可能会改善这些患者的临床结局并降低入院费用。
