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Esophageal erosions — Clinical Guidelines

Overview

Esophageal erosions refer to injuries or lesions within the esophageal lining, often resulting from endoscopic procedures, foreign body impaction, or other mechanical or pathological causes. These erosions can lead to complications such as bleeding, perforation, and obstruction.

Diagnosis

Clinical Presentation: Dysphagia, chest pain, and potential complications like bleeding or perforation.

Endoscopic Evaluation: Essential for visualizing erosions and assessing extent and severity.

Imaging: Chest X-ray or CT may be used to detect complications like pneumomediastinum or perforation.

Laboratory Tests: White blood cell count elevation may indicate infection or inflammation 3.

Management

Endoscopic Treatment: Primary approach for managing erosions, including endoscopic resection techniques 2.

Anesthesia Considerations: General anesthesia may reduce acute complications compared to conscious sedation 1.

Foreign Body Removal: Flexible endoscopy is effective with a lower complication rate compared to rigid esophagoscopy 5.

Complication Management: Prompt intervention for perforation, bleeding, or obstruction, potentially requiring surgical repair 1 6.

Special Populations

Pediatrics: Flexible endoscopy is preferred for foreign body extraction due to lower complication rates 5.

Comorbidities: Patients with preexisting esophageal disorders (e.g., strictures, esophagitis) may require specialized care 6.

Key Recommendations

Use General Anesthesia for ESD Procedures to Minimize Acute Complications (Evidence: Strong 1).

Prefer Flexible Endoscopy for Esophageal Foreign Body Removal in Adults (Evidence: Moderate 5).

Consider Patient-Specific Comorbidities When Choosing Endoscopic Techniques (Evidence: Expert opinion 6).

Rigorously Monitor for and Manage Complications Such as Bleeding and Perforation Promptly (Evidence: Moderate 1 6).

References

1 Kim SH, Choi YS, Lee SK, Oh H, Choi SH. Comparison of general anesthesia and conscious sedation in procedure-related complications during esophageal endoscopic submucosal dissection. Surgical endoscopy 2020. link 2 van Vilsteren FG, Pouw RE, Alvarez Herrero L, Bisschops R, Houben M, Peters FT et al.. Learning endoscopic resection in the esophagus. Endoscopy 2015. link 3 Uemura M, Ishii N, Itoh T, Suzuki K, Fujita Y. Effects of carbon dioxide insufflation in esophageal endoscopic submucosal dissection. Hepato-gastroenterology 2012. link 4 Kutner MA, Bromberg A, Korst RJ, Lee BE. An unusual case of dysphagia from intrathoracic liver. The Annals of thoracic surgery 2010. link 5 Berggreen PJ, Harrison E, Sanowski RA, Ingebo K, Noland B, Zierer S. Techniques and complications of esophageal foreign body extraction in children and adults. Gastrointestinal endoscopy 1993. link70212-6) 6 Lewis JH. Esophageal and small bowel obstruction from guar gum-containing "diet pills": analysis of 26 cases reported to the Food and Drug Administration. The American journal of gastroenterology 1992. link 7 Wang PY, Chen CY, Chen CL. A check-valve device for prevention of regurgitation after endoesophageal intubation. The Annals of thoracic surgery 1986. link60585-1) 8 Han SY, Flint A, McElvein RB. Bezoar of the esophagus. Gastrointestinal radiology 1980. link 9 Thornley PE, Wallwork J. Spontaneous rupture of the oesophagus and massive pneumoperitoneum. The British journal of surgery 1978. link

Esophageal erosions