Role of flexible endoscopy in the evaluation of possible esophageal traumaafter penetrating injuries

OBJECTIVE: In urban medical centers, penetrating injuries of the chest, nec k, and head are frequently encountered due to the use of firearms and sharp weapons: Successful management of esophageal injury requires a high index of suspicion and prompt diagnosis; The role of flexible endoscopy, a readil y available modality, has not been studied extensively in the management of potential esophageal injuries due to trauma. METHODS: A retrospective chart review of 55 patients who underwent emergent flexible endoscopy for the evaluation of suspected penetrating esophageal injuries was performed to determine if endoscopy was safe and if it yielded information that altered patient management. RESULTS: Flexible endoscopy was performed safely in all patients. It yielde d a sensitivity of 100%, specificity of 92.4%, a negative predictive value of 100%, and a positive predictive value of 33.3% for detecting an esophage al injury. Although positive findings (prevalence, 3.6%) are infrequent, no esophageal injuries were missed. Endoscopy altered patient management in 3 8 (69.1%) patients. CONCLUSIONS: Emergent flexible endoscopic examination of the esophagus is a safe and useful diagnostic tool in the early evaluation of penetrating inj uries. Flexible endoscopy resulted in four negative surgical explorations, which was deemed acceptable by the Trauma Service, as the consequences of a missed esophageal injury is likely to be devastating. (C) 2000 by Am. Cell . of Gastroenterology.