Department of Digestive Surgery and Transplantation, University Hospital of Lille Nord de France, Lille, France.
Department of Biostatistics, University Hospital of Lille Nord de France, Lille, France.
Dis Esophagus. 2024 Apr 27;37(5). doi: 10.1093/dote/doae001.
Nonoperative management of severe caustic injuries has demonstrated its feasibility, avoiding the need for emergency esogastric resection and resulting in low mortality rates. However, leaving superficial necrosis in place could increase the risk of esophageal stricture development. Data on the risk factors of esophageal stricture secondary to caustic ingestion are scarce. The aim of our study was to identify the risk factors for esophageal strictures after caustic ingestion at admission. From February 2015 to March 2021, all consecutive patients with esophageal or gastric caustic injury score ≥ II according to the Zargar classification were retrospectively analyzed. For each patient, we collected over 50 criteria at admission to the emergency room and then selected among them 20 criteria with the best clinical relevance and limited missing data for risk factor analyses. Among the 184 patients included in this study, 37 developed esophageal strictures (cumulative rate 29.4%). All esophageal strictures occurred within 3 months. In multivariate analyses, the risk factors for esophageal strictures were voluntary ingestion (cause-specific hazard ratio 5.92; 95% confidence interval 1.76-19.95, P = 0.004), Zargar's esophageal score ≥ III (cause-specific hazard ratio 14.30; 95% confidence interval 6.07-33.67, P < 0.001), and severe ear, nose, and throat lesions (cause-specific hazard ratio 2.15; 95% confidence interval 1.09-4.22, P = 0.027). Intentional ingestion, severe endoscopic grade, and severe ENT lesions were identified as risk factors for esophageal stricture following caustic ingestion. Preventive measures for this population require further evaluation.
非手术治疗严重腐蚀性损伤已证明其可行性，避免了紧急胃食管切除术的需要，并导致低死亡率。然而，让浅层坏死留在原处可能会增加食管狭窄发展的风险。关于腐蚀性摄入导致食管狭窄的危险因素的数据很少。我们的研究目的是确定腐蚀性摄入后食管狭窄的危险因素。从 2015 年 2 月至 2021 年 3 月，根据 Zargar 分类，对所有连续患有食管或胃腐蚀性损伤评分≥II 的患者进行回顾性分析。对于每位患者，我们在急诊科入院时收集了超过 50 项标准，然后从中选择了 20 项具有最佳临床相关性和有限缺失数据的标准进行危险因素分析。在这项研究中包括的 184 名患者中，有 37 名患者出现食管狭窄（累积发生率为 29.4%）。所有食管狭窄均发生在 3 个月内。在多变量分析中，食管狭窄的危险因素是自愿摄入（特定原因的危险比 5.92；95%置信区间 1.76-19.95，P=0.004）、Zargar 的食管评分≥III（特定原因的危险比 14.30；95%置信区间 6.07-33.67，P<0.001）和严重的耳、鼻、喉损伤（特定原因的危险比 2.15；95%置信区间 1.09-4.22，P=0.027）。有意摄入、严重内镜分级和严重耳鼻喉损伤被确定为腐蚀性摄入后食管狭窄的危险因素。需要进一步评估针对这一人群的预防措施。
