LAUSR

our aim was to evaluate if CT could predict outcomes in terms of treatment in patient with caustic ingestion injury. endoscopy has long been the gold standard for initial evaluation of caustic ingestion injury. Lately several studies suggested CT-scans to have an equal or even superior accuracy in emergency evaluation and prediction of esophageal stricture formation. Wishing to avoid complications of endoscopic procedures, new radiological grading system are being defined to supplement or replace the ones currently used. On the basis of the available evidence, we proposed a radiological 3 grade-score: grade I (well-defined visceral wall, homogenous post-contrastographic enhancement, no wall/perivisceral fat tissue edema), grade IIA (thickened and hypointense mucosa with post-contrastographic enhancement, wall/perivisceral fat tissue edema), grade IIB (necrotic mucosa with slight post-contrastographic external wall enhancement), grade III (transmural necrosis, defined by two of three between: lack of post-contrastografic wall enhancement, not defined visceral wall, blurred perivisceral fat tissue). Retrospectively we collected patients’ CT-scans which were reviewed by a radiologist, two senior surgeons and six resident surgeons; CT-scans performed within 48 hours after the ingestion were considered significant. We also tracked patients’ clinical history and compared the outcomes. of 50 patients that were admitted in our division in the last 10 years, we reviewed CT-scans of 23 patients; 15 were performed within 48 hours after the caustic ingestion. From the analysis of the data we observed that clinicians scored similarly, especially for grades I and III. Of these patients, 26,6 % had elective surgery (I: 0%; IIA: 0%; IIB: 75%; III: 25%), 20 % underwent emergency surgery (I: 0%; IIA: 33%; IIB: 0%; III: 66%), 53,4 % had conservative management (I: 25%; IIA: 12,5%; IIB: 37,5%; III: 25%). For what concerns the effectiveness of the score, we found high negative predictive value for grade I (all patients were treated conservatively), although highest grade had good specificity (0,86) regarding the needs of reconstructive surgery. our radiological classification seems a worthwhile tool at the two extreme grades; on the contrary, for intermediate scores is still necessary an endoscopic-integrated approach to define which treatment achieve.