FLEXIBLE ENDOSCOPY FOR THE DIAGNOSIS OF ESOPHAGEAL TRAUMA

The role of flexible endoscopy in the diagnosis of esophageal trauma r emains undefined. This study evaluates the use of immediate flexible f iberoptic esophagogastroduodenoscopy (EGD) as the primary diagnostic t ool for detection of esophageal injury in trauma patients. Flexible EG D was performed on 31 patients for this purpose from August 1991 throu gh January 1994. There were 28 males and 3 females with a mean age of 24.3 years (range, 16-54 years). Twenty-four of 31 patients (77%) were intubated at the time of the examination. Mechanism of injury was pen etrating in 24 patients (20 gunshot wounds, four stab wounds) and blun t (motor vehicle crash) in seven patients. Penetrating injuries were l ocated in the neck in 5 of 24 patients, in the chest in 15 of 24 patie nts, and in both the neck and chest in 4 of 24 patients. Upper gastroi ntestinal contrast studies were performed for 3 of 31 patients (10%), computed tomography was performed for eight patients (26%), bronchosco py was performed for 13 patients (42%), angiography was performed for 17 patients (55%), and rigid esophagoscopy and laryngoscopy were each performed for one patient (3%). Evidence of esophageal trauma during E GD was seen in 5 of 31 patients. True-positive studies occurred for fo ur patients, false-positive results occurred for one patient, true-neg ative results occurred for 26 patients (as demonstrated by exploration in five and clinical follow-up in 21), and no false-negative examinat ions occurred. Sensitivity of flexible EGD was 100%, specificity was 9 6%, and accuracy was 97%. No complications occurred related to the per formance of EGD. Flexible fiberoptic endoscopy seems to be a safe and effective method for both detection and exclusion of esophageal trauma .