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Hépato-Gastro & Oncologie Digestive

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Management of caustic ingestions: No more room for emergency endoscopy Volume 27, issue 9, Novembre 2020

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Authors
1 Hôpital Saint-Louis, Service de gastroentérologie, 1 Avenue Claude Vellefaux, 75010 Paris
2 Hôpital Saint-Louis, Service de radiologie, 1 Avenue Claude Vellefaux, 75010 Paris
3 Hôpital Saint-Louis, Service de chirurgie digestive, 1 Avenue Claude Vellefaux, 75010 Paris
* Correspondance

Ingestion of caustics represents a medical and surgical emergency. In adults, it is most often suicidal and its severity depends on the nature and quantity of the ingested product. Management should be multidisciplinary. The initial challenge is to identify patients requiring emergency surgical resection for life-threatening transmural necrosis of the gastrointestinal tract. Upper gastrointestinal endoscopy has no longer a place in the acute phase of ingestion. The decisional algorithm is now based on the injected CT scan with a dedicated classification and good inter-observer reproductibility. The contribution of imaging has made possible to extend the indications for conservative treatment, which can be carried out in about three quarters of the patients. In this case, re-feeding must be very early. There is no validated drug treatment to promote wound healing. If esophageal stenosis occurs later, endoscopic dilatation is the first-line treatment.