Detection of caustic oesophageal injury with technetium 99m-labelled sucralfate

Background/Purpose: Radiolabelled sucralfate has been used to show the exte nt and severity of reflux oesophagitis, peptic ulceration, and inflammatory bower disease. Endoscopy under general anaesthetic has been the preferred method to assess the injury after caustic ingestion. The aim of this study was to assess whether sucralfate has an affinity for the chemically injured oesophageal mucosa and, if so, to assess the accuracy of radiolabeled sucr alfate as an indicator of presence and extent of oesophageal injury. Methods: A prospective study was conducted of 22 patients with mean age of 30 months (range, 13 to 90) admitted consecutively with a history of causti c ingestion between January 1998 and January 2000. A sucralfate-labelled sc an followed by endoscopic assessment of upper gastrointestinal tract with d ocumentation of extent and grade of injury was performed in all patients wi thin 24 hours of admission except the first 6 who underwent scan after the endoscopy. The sucralfate was labelled by the direct stannous reduction met hod. Oesophageal transit was studied by recording 120 images (64 x 64 matri x size) at 1 image per second while the child swallowed 5 mL of labelled su cralfate containing 2 to 3MBq Technetium 99m. Retention of radiolabelled oe sophageal activity was considered abnormal. Results: The caustic substances ingested were household cleaners in 18, pot assium permanganate in 3, and pool chlorine in 1.There were 11 scans that s howed residual activity in the oesophagus, which correlated exactly with en doscopic findings. The other 11 patients had normal oesophageal mucosa, but 2 were found to be falsely positive on scanning. In 2 cases repeat sucralf ate scan results correlated well with the healing process assessed endoscop ically. Conclusions: The results indicate that technetium 99m sucralfate swallow is an accurate technique for assessing oesophageal injury after ingestion of caustic substances. In addition, it may be used to document healing. Copyri ght (C) 2001 by W.B. Saunders Company.