Accidental caustic ingestion in children: Is endoscopy always mandatory?

Background: Patients who have experienced severe caustic injury to the gast rointestinal tract are at high risk of esophageal strictures. Early endosco py is usually recommended systematically in children after caustic ingestio n to assess the severity of the initial digestive lesions. The aim of this study was to determine the predictive value of clinical symptoms and ingest ed-substance types as markers of severe esophagogastric lesions and to defi ne indications for endoscopy. Methods: Ingested-product types, clinical symptoms, endoscopic data and out come were prospectively recorded in 85 children admitted after accidental c austic ingestion. Results: Forty-eight children (57%) had no symptoms; the others presented w ith vomiting, hematemesis, drooling, respiratory distress, and/or oropharyn geal lesions. Endoscopy showed no or minimal lesions in 63 cases (74%). Non e of the children developed digestive sequelae. Severe esophagogastric lesi ons were present in 22 cases (26%), mostly caused by lye ingestion (14 of 2 2) but also by strong acids (4 of 22); 9 of the 22 children (41%) developed esophageal stenosis. Vomiting, drooling, and oropharyngeal lesions did not predict severe endoscopic lesions. Hematemesis, respiratory distress, or p resence of at least three of the symptoms was associated with severe lesion s (positive predictive value = 1). The absence of symptoms was always assoc iated with no or minimal lesions (negative predictive value = 1). Conclusions: In conclusion, endoscopy is not recommended for children livin g in developed countries who are asymptomatic after accidental caustic inge stion.