Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France.
Université de Paris, Department of Biomedical Statistics Saint-Louis Hospital, Paris, France.
Dis Esophagus. 2022 Nov 15;35(11). doi: 10.1093/dote/doac032.
Computed tomography (CT) is used increasingly for the emergency assessment of caustic injuries and the need for emergency endoscopy has been challenged. The study evaluates outcomes of caustic ingestion in the modern era and the feasibility of abandoning emergency endoscopy. Between 2013 and 2019, 414 patients (197 men, median age 42 years) were admitted for caustic ingestion. Emergency and long-term outcomes of patients managed by CT and endoscopy (n = 120) and by CT alone (n = 294) were compared. Propensity score-based analysis was performed to limit bias of between-group comparison. A standard mortality ratio (SMR) was used to compare the observed mortality with the expected mortality in the general French population. Complications occurred in 97 (23%) patients and 17 (4.1%) patients died within 90 days of ingestion. Among 359 patients who underwent nonoperative management, 51 (14%) experienced complications and 7 (2%) died. Of 55 patients who underwent emergency surgery, 46 (84%) experienced complications and 10 (18%) died. The SMR was 8.4 for whole cohort, 5.5 after nonoperative management, and 19.3 after emergency surgery. On multivariate analysis, intentional ingestion (P < 0.016), age (P < 0.0001) and the CT grade of esophageal injuries (P < 0.0001) were independent predictors of survival. The CT grade of esophageal injuries was the only independent predictor of success (P < 0.0001). Crude and propensity match analysis showed similar survival in patients managed with and without endoscopy. CT evaluation alone can be safely used for the emergency management of caustic ingestion.
计算机断层扫描（CT）越来越多地用于腐蚀性损伤的急诊评估，急诊内镜的必要性受到了挑战。本研究评估了腐蚀性摄入的现代时代的结果，并探讨了放弃急诊内镜的可行性。在 2013 年至 2019 年期间，有 414 名患者（197 名男性，中位年龄 42 岁）因腐蚀性摄入而住院。比较了通过 CT 和内镜（n=120）以及仅通过 CT（n=294）治疗的患者的急诊和长期结局。进行了倾向评分匹配分析以限制组间比较的偏倚。标准死亡率（SMR）用于比较一般法国人群中的观察死亡率和预期死亡率。并发症发生在 97 名（23%）患者中，17 名（4.1%）患者在摄入后 90 天内死亡。在 359 名接受非手术治疗的患者中，51 名（14%）发生并发症，7 名（2%）死亡。在 55 名接受紧急手术的患者中，46 名（84%）发生并发症，10 名（18%）死亡。整个队列的 SMR 为 8.4，非手术治疗后为 5.5，紧急手术后为 19.3。多变量分析显示，故意摄入（P<0.016）、年龄（P<0.0001）和食管损伤的 CT 分级（P<0.0001）是生存的独立预测因素。食管损伤的 CT 分级是成功的唯一独立预测因素（P<0.0001）。未匹配和倾向评分匹配分析显示，内镜治疗和非内镜治疗患者的生存率相似。单独的 CT 评估可安全用于腐蚀性摄入的急诊管理。
