Alkaline esophagitis evaluated by endoscopic ultrasound

Gastric stenosis in severe corrosive gastritis: prognostic evaluation by endoscopic ultrasonography

INTRODUCTION

Endoscopic ultrasonography can provide high-resolution images of the gastric wall.

CASE REPORT

A 24-year-old woman with severe corrosive gastritis following massive ingestion of an alkaline household chemical was examined with endoscopic ultrasonography using a 20-MHz probe. Endoscopic ultrasonography disclosed diffuse thickening of the entire gastric wall and lack of demarcation of the muscular layer in the antrum. Several weeks after the ingestion, stenosis developed in the antrum and was treated with laparoscopic gastrectomy.

DISCUSSION

Endoscopic ultrasonography can provide accurate evaluation of depth of lesions in corrosive gastritis and may be useful in predicting gastric stenosis.

Prediction of bleeding and stricture formation after corrosive ingestion by EUS concurrent with upper endoscopy

BACKGROUND

Upper endoscopy provides information that can be used to predict complications and to facilitate clinical decisions for patients who have ingested corrosive substances. The role of EUS in corrosive injury has not been investigated. The aim of this study was to determine whether concurrent catheter-probe EUS provides additional information that predicts complications after corrosive injury.

METHODS

Eighteen patients were referred (from 1997 to 2003) for EGD and concurrent EUS within 24 hours after ingestion of a caustic agent. Two patients were excluded (1 pneumoperitoneum, 1 markedly swollen cricoarytenoid cartilage/epiglottis). The severity of injury in the different segments of the esophagus and stomach was graded (0, 1, 2a, 2b, 3a, 3b) by endoscopy and by EUS (0, M, SM, MP, SS). The development of complications during hospitalization and 3-month follow-up were recorded.

OBSERVATIONS

All 16 patients underwent EGD with EUS without complication. The frequency of early and late complications increased as the endoscopic and the EUS severity grades increased. The accuracy of prediction of bleeding or stricture was 100% when endoscopic grade 3a was used as a cutoff. For EUS, the highest accuracy was observed in the prediction of bleeding (75%) and stricture (100%) when EUS grade MP was used as a cutoff.

CONCLUSIONS

EUS can be performed safely within 24 hours of ingestive of corrosive substances. However, when used in conjunction with conventional endoscopic observation, it does not increase the accuracy for prediction of early or late complications. Standard endoscopy alone is sufficient for evaluation and prediction of bleeding and stricture complications after corrosive injury in the upper-GI tract.

Miniprobe ultrasonography for determining prognosis in corrosive esophagitis

OBJECTIVE

We evaluated the ability of endoscopic ultrasonography to predict likelihood of stricture formation in patients with corrosive esophagitis.

METHODS

Consecutive patients with esophagitis resulting from alkaline or acid chemical ingestion (n = 11) were evaluated prospectively by endoscopic ultrasonography between hospital days 4 and 12. Findings for the most severe lesion were classified according to the appearance of the muscular layers: distinct muscular layers without thickening (grade 0); distinct muscular layers with thickening (grade I); obscured muscular layers with indistinct margins (grade II); and muscular layers that could not be differentiated (grade III). Findings were also classified according to whether apparent damage to muscular layers in the worst-appearing image involved part of the circumference (type a) or the whole circumference (type b). Implications of these findings for subsequent stricture formation were then evaluated.

RESULTS

Stricture formation did not occur in patients with grade 0 or grade I images; transient stricture formation occurred in a patient showing grade IIa. Stricture requiring repeated bougie dilation occurred in a patient showing grade IIIb.

CONCLUSIONS

Endoscopic ultrasonographic images presumed to reflect the destruction of muscular layers (grades II to III), as opposed to only edema (grade I), may be associated with stricture formation. This modality can accurately visualize deep lesions in corrosive esophagitis, making it prognostically useful.