Role of endoscopy in caustic injury of the esophagus

Table 1 Assessment of severity: endoscopic score and computerized tomography score

Grade	Endoscopic score[16]	score[21]
I	Edema and hyperemia of the mucosa	No definite swelling of esophagus wall (< 3 mm, within normal limit)
II	IIa: Friability, hemorrhages, erosion, blisters, whitish membranes, exudates and superficial ulcerations IIb: IIa with deep or circumferential ulceration	Edematous wall thickening (> 3 mm) without periesophageal soft tissue infiltration
III	IIIa: Small scattered areas of necrosis IIIb: Extensive necrosis	Edematous wall thickening with periesophageal soft tissue infiltration plus well-demarcated tissue interface
IV	Perforation	Edematous wall thickening with periesophageal soft tissue infiltration plus blurring of tissue interface or localized fluid collection around the esophagus or the descending aorta

Table 2 Variations in the degree of injury according to Zargar’s classification from articles published after year 2000 in adult patients

Author	Year	Patients	Grade I	Grade II	Grade III
Alipour Faz et al[4]	2017	313	42.5%	16.9%	20.1%
Ducoudray et al[7]	2016	n/a	n/a	n/a	39.7%
Cabral et al[11]	2012	315	12.7%	22.9%	29.2%
Chang et al[25]	2011	389	14.7%	39.3%	42.4%
Cheng et al[21]	2008	273	n/a	n/a	30%
Tohda et al[26]	2008	95	49.4%	26.3%	13.7%
Havanond et al[12]	2007	148	17%	41%	1%
Satar et al[27]	2004	37	67.5%	n/a	0%
Poley et al[18]	2004	179	40%	30%	30%
Rigo et al[28]	2002	210	32%	13%	6%

n/a: Not available.

Table 3 Techniques of esophageal dilatation

Early dilate (usually starting from 3 wk after caustic ingestion)

Use appropriate type and size of dilator

Maintain a dilator in lumen of the esophagus while dilating

Concern the rule of 3: Never dilate more than 3 dilators of progressively increasing diameter after considerable resistance is encountered

Weekly or bi-weekly dilate to obtain luminal competency at 40 Fr

Dilate per scheduled, not on demand

If chest pain occurs after dilatation, esophageal perforation must be rule out using contrast esophagography