Singh AK, Birda CL, Kochhar R. Optimizing triage in acute caustic ingestion: Choosing between endoscopy and computed tomography. World J Gastrointest Endosc 2026; 18(3): 114327 [DOI: 10.4253/wjge.v18.i3.114327]
Corresponding Author of This Article
Rakesh Kochhar, DM, Professor, Department of Gastroenterology, Paras Hospital, F-Block Ground Floor, Panchkula 134109, India. dr_kochhar@hotmail.com
Research Domain of This Article
Emergency Medicine
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Minireviews
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World J Gastrointest Endosc. Mar 16, 2026; 18(3): 114327 Published online Mar 16, 2026. doi: 10.4253/wjge.v18.i3.114327
Optimizing triage in acute caustic ingestion: Choosing between endoscopy and computed tomography
Anupam K Singh, Chhagan L Birda, Rakesh Kochhar
Anupam K Singh, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Chhagan L Birda, Department of Gastroenterology, All India Institute of Medical Sciences, Jodhpur 342005, India
Rakesh Kochhar, Department of Gastroenterology, Paras Hospital, Panchkula 134109, India
Author contributions: Singh AK and Birda CL contributed to the initial manuscript writing and literature search; Singh AK and Kochhar R performed critical revision of the manuscript; and all authors read and approved the published version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Rakesh Kochhar, DM, Professor, Department of Gastroenterology, Paras Hospital, F-Block Ground Floor, Panchkula 134109, India. dr_kochhar@hotmail.com
Received: September 18, 2025 Revised: November 17, 2025 Accepted: January 6, 2026 Published online: March 16, 2026 Processing time: 176 Days and 11.2 Hours
Abstract
Acute caustic ingestion is a medical emergency that can cause a wide spectrum of gastrointestinal injuries, making timely and accurate triage essential. Early esophagogastroduodenoscopy, performed within 12-24 hours, remains the gold standard for assessing mucosal injury but cannot evaluate transmural or extra-luminal involvement. Computed tomography (CT) has been increasingly used as a valuable alternative tool, providing cross-sectional assessment of the gastrointestinal wall and surrounding tissues and enabling early detection of complications such as necrosis, perforation, mediastinitis, and peritonitis. However, CT carries its own limitations, including radiation exposure, variable acquisition protocols, and the lack of standardized grading systems. Therefore, the optimal choice between esophagogastroduodenoscopy and CT remains an area of ongoing research, and in practice, the two modalities are best viewed as complementary rather than mutually exclusive.
Core Tip: Endoscopy best assesses mucosal injury, but it cannot reliably evaluate transmural or extra-luminal complications. Computed tomography provides complementary cross-sectional information, identifying necrosis, perforation, and mediastinal or peritoneal involvement, and is especially valuable when endoscopy is contraindicated or inconclusive. Together, they provide a comprehensive evaluation that improves risk stratification and guides management in acute caustic ingestion.
