EMERGENT UPPER GASTROINTESTINAL ENDOSCOPY IN CHILDREN - A REVIEW OF 848 CASES

Indications for emergent upper gastrointestinal tract (UGIT) endoscopy are-ingestion of corrosive agents, hematemesis, and foreign bodies lo dged in the esophagus. A three-year retrospective study was conducted to determine the place of and reasons for emergent UGIT endoscopy in p ediatric patients. Patients and methods: Eight hundred forty-eight (45 %) of the 1881 UGIT endoscopies performed between January I 1990, and December 31, 1992, were done on an emergency basis. Mean patient age w as four years (range two days to 14 years). An Olympus P20 endoscope w as used in every case. Results: Ingestion of a corrosive agent, was th e most common reason for performing UGIT endoscopy (560 cases, 66%). A bnormalities were seen in 11.8% of cases overall, in 8.2% of cases of bleach ingestion, and in 31.7% of cases of ingestion of other corrosiv e agents. Lesions were as follows: corrosive esophagitis stage III (9% ), stage II (28.7%), or stage I (53%); gastric necrosis (7.5%), and co ngestive gastritis (22.7%). Slightly more than half(55.2%) the patient s with hematemesis had endoscopic abnormalities, which were ditributed as follows: gastritis and esophagitis (27.5%), peptic esophagitis (13 .5%), gastroduodenal ulcers (7.3%), and esophageal varices (5.5%). Con clusion: In Tunisia, ingestion of corrosive agents is unfortunately st ill the most common reason for emergent UGIT endoscopy in children. In addition to primary prevention, high-dose methylprednisolone is a pro mising therapeutic alternative for preventing esophageal strictures ca used by corrosive esophagitis.