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Caustic ingestion
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of caustic ingestion are prepared by our editorial team based on guidelines from the American Society for Gastrointestinal Endoscopy (ASGE 2021), the World Society of Emergency Surgery (WSES 2019), and the British Society of Gastroenterology (BSG 2018).
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Diagnostic investigations
Initial assessment: as per WSES 2019 guidelines, determine the nature, the physical form, and the quantity of the ingested agent as well as the accidental-voluntary ingestion pattern for emergency management of corrosive injuries.
B
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Contacting Poison Control Centers
Laboratory studies
Diagnostic imaging
Diagnostic procedures
Upper gastrointestinal endoscopy
As per WSES 2019 guidelines:
Perform emergency endoscopy if CT is unavailable, CT with contrast administration is contraindicated (renal failure, iodine allergy), CT suggests transmural esophageal necrosis but interpretation is difficult or uncertain, or in pediatric patients.
B
Perform upper gastrointestinal endoscopy for esophageal/gastric strictures in symptomatic patients.
B
Nonpharmacologic interventions
Therapeutic procedures
Surgical interventions
Specific circumstances
Patients with gastric outlet obstruction: as per ASGE 2021 guidelines, insufficient evidence to uniformly support either endoscopic or surgical management in patients with mixed varieties of benign gastric outlet obstruction. Take into account the etiology of benign gastric outlet obstruction, length of stricture, and response to initial endoscopic balloon dilation in determining appropriate management.
I