Caustic ingestion in children: is endoscopy always indicated? The results of an Italian multicenter observational study

Background: The ingestion of caustic substances can represent a serious medical problem in children. Objective: Whether or not an urgent endoscopy should be performed is still a matter of debate, particularly in asymptomatic patients. Design: We conducted a multicenter observational study to investigate the predictive value of signs and symptoms in detecting severe esophageal lesions. Setting and Patients: The records of 162 children who presented with accidental caustic substance ingestion were analyzed. Interventions: Signs and symptoms were divided into minor (oral and/or oropharyngeal lesions and vomiting) and major (dyspnea, dysphagia, drooling, and hematemesis). An endoscopy was performed in all patients within 12 to 24 hours of the substance being ingested. Main Outcome Measurements: The types of substance ingested, signs and symptoms, age, sex, and severity of esophageal injury were correlated. Results: Mild esophageal lesions were identified in 143 of 162 patients (88.3%), and severe (third degree) esophageal lesions in 19 patients (11.7%). The risk of severe esophageal lesions without signs and/or symptoms was very low (odds ratio [OR] 0.13 [95% CI, 0.02-0.62], P = .002). Indeed, the presence of 3 or more symptoms is an important predictor of severe esophageal lesions (OR 11.97 [95% CI, 3.49-42.04], P = .0001). Multivariate analysis showed that the presence of symptoms is the most significant predictor of severe esophageal lesions (OR 2.3 [95% CI, 1.57-3.38], P = .001). Conclusions: The results demonstrated that the incidence of patients with third-degree lesions without any early symptoms and/or signs is very low, and an endoscopy could be avoided. The risk of severe damage increases proportionally with the number of signs and symptoms, and an endoscopy is always mandatory in symptomatic patients.