Guideline sources The following summarized guidelines for the evaluation and management of caustic ingestion are prepared by our editorial team based on guidelines from the American Society for Gastrointestinal Endoscopy (ASGE 2021) and the World Society of Emergency Surgery (WSES 2019). 1 2 Guidelines 1. Diagnostic investigations History taking: determine the nature, the physical form, and the quantity of the ingested agent as well as the accidental-voluntary ingestion pattern for emergency management of corrosive injuries. B Contacting Poison Control Centers: contact Poison Control Centers to assess systemic toxicity of the ingested agents. B Laboratory studies: Obtain initial laboratory tests: CBC (bili bi ALT AST) https://web.pathway.md/diseases/recAz2NRiysPaNNre li t t 1/4 6/29/23, 3:46 AM Caustic ingestion Pathway liver tests (bilirubin, ALT, AST) urea creatinine electrolytes (sodium, potassium, chlorine, magnesium, calcium) pH serum lactate blood alcohol -hCG (in young female patients). B Imaging: Consider neck, chest, and abdominal XRs which may show the presence of free air in patients with gastrointestinal perforation. B Obtain CT as emergency management of caustic ingestion can be performed safely relying on it. B 2. Diagnostic procedures Upper gastrointestinal endoscopy: Perform emergency endoscopy if CT: is unavailable with contrast administration is contraindicated (renal failure, iodine allergy) suggests transmural esophageal necrosis but interpretation is difficult or uncertain. B Show 2 more 3. Nonpharmacologic interventions Indications for non-surgical management: Offer non-surgical management for patients who do not have full-thickness necrosis of digestive organs. B Repeat CT and consider for surgery if any deterioration in the condition of the patient is reported. B 4. Therapeutic procedures Endoscopic dilation: attempt endoscopic dilation 3-6 weeks after ingestion in patients with few (< 3) short (< 5 cm) esophageal strictures. B 5. Surgical interventions Surgery: consider reconstructive esophageal surgery after recurrent failure of endoscopic dilation. B Show 3 more https://web.pathway.md/diseases/recAz2NRiysPaNNre 2/4 6/29/23, 3:46 AM Caustic ingestion Pathway 6. Specific circumstances Patients with gastric outlet obstruction: insufficient evidence to uniformly support either endoscopic or surgical management in patients with mixed varieties of benign gastric outlet obstruction. Take into account the etiology of benign gastric outlet obstruction, length of stricture, and response to initial endoscopic balloon dilation in determining appropriate management. I 7. Follow-up and surveillance Psychiatric evaluation: obtain psychiatric evaluation in all patients before hospital discharge. B Clinical findings Patient demographics Symptoms Children Abdominal pain Chest pain Past medical history Cough Dysphagia Esophageal perforation Epigastric pain Intestinal perforation Hematemesis Stomach perforation Hoarseness Head and neck exam Odynophagia Vomiting Drooling Tongue swelling Neurological exam Abdominal exam Altered mental status Dysphonia Peritoneal findings Rebound tenderness Respiratory exam Choking Stridor Imaging findings Subcutaneous emphysema References 1. Mircea Chirica, Michael D Kelly, Stefano Siboni et al. Esophageal emergencies: WSES guidelines. World J Emerg Surg. 2019 May 31;14 26. Open https://web.pathway.md/diseases/recAz2NRiysPaNNre 3/4 6/29/23, 3:46 AM Caustic ingestion Pathway 2. ASGE Standards of Practice Committee, Terry L Jue, Andrew C Storm et al. ASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction. Gastrointest Endosc. 2021 Feb;93 2 309 322.e4. Open https://web.pathway.md/diseases/recAz2NRiysPaNNre 4/4