Overview
Esophageal injury encompasses damage to the esophagus from various causes, including corrosive ingestion, surgical complications, and foreign body impaction, leading to significant morbidity and potential mortality. 1234Diagnosis
Clinical Presentation: Symptoms vary but often include dysphagia, chest pain, and in severe cases, respiratory distress or sepsis.
Imaging: Emergency CT can classify injuries (Grade I-IIb) and predict stricture risk (Grade I: 0% risk, Grade IIa: 17% risk, Grade IIb: 83% risk). 2
Endoscopy: Remains the gold standard for detailed injury assessment and grading (e.g., Zargar classification). 2
Special Techniques: Image analysis methods offer objective assessment of stricture severity, complementing traditional stenosis indices. 5Management
Emergency Surgery: Indicated for severe corrosive injuries; reconstructive surgery post-resection improves nutritional outcomes (94% achieving autonomy). 1
Conservative Management: For less severe cases, endoscopic monitoring and dilation may be employed.
Preventive Measures: In button-battery ingestion, prompt removal and monitoring for complications (23% complication rate noted). 3
Supportive Care: Includes nutritional support, infection control, and management of complications like abscesses and osteomyelitis. 4
Technological Aids: Adaptors for flexible bronchoscopes enable outpatient pediatric oesophagoscopy, aiding precise injury assessment. 6Special Populations
Children: High risk of esophageal lesions from button-battery ingestion; preventive measures crucial, including securing battery compartments. 3
Elderly and Comorbidities: Not specifically detailed in abstracts; however, nutritional and psychiatric status significantly impact outcomes post-injury. 1Key Recommendations
Immediate Surgical Intervention for Severe Corrosive Injuries: Consider emergency surgery with subsequent reconstructive efforts to enhance long-term nutritional outcomes. (Evidence: Strong 1)
Utilize CT Grading for Predicting Esophageal Stricture Risk: Employ CT classification to stratify patients for stricture risk and guide follow-up strategies. (Evidence: Moderate 2)
Prompt Removal and Monitoring for Button-Battery Ingestion: Ensure rapid removal and close monitoring in pediatric cases to mitigate complications. (Evidence: Moderate 3)
Supportive Care Including Nutritional Support and Infection Control: Essential for managing complications such as leaks, abscesses, and osteomyelitis post-injury. (Evidence: Moderate 4)
Leverage Advanced Endoscopic Techniques for Pediatric Assessment: Use specialized adaptors for flexible endoscopes to facilitate outpatient evaluations in children. (Evidence: Expert opinion 6)References
1 Chobarporn T, Mesiri D, Tharavej C. Long-term outcomes of patients undergoing emergency surgery for corrosive injury of the upper digestive tract. Surgery today 2025. link
2 Bruzzi M, Chirica M, Resche-Rigon M, Corte H, Voron T, Sarfati E et al.. Emergency Computed Tomography Predicts Caustic Esophageal Stricture Formation. Annals of surgery 2019. link
3 Lahmar J, Célérier C, Garabédian EN, Couloigner V, Leboulanger N, Denoyelle F. Esophageal lesions following button-battery ingestion in children: Analysis of causes and proposals for preventive measures. European annals of otorhinolaryngology, head and neck diseases 2018. link
4 Rueth N, Shaw D, Groth S, Stranberg S, D'Cunha J, Sembrano J et al.. Management of cervical esophageal injury after spinal surgery. The Annals of thoracic surgery 2010. link
5 Vardar E, Vardar R, Yükselen V, Makay O, Erkan N, Bayol U et al.. Image-based assessment of esophageal stricture in experimental corrosive esophagitis in animals: an objective, adjunct diagnostic tool. The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology 2009. link
6 Prescott CA. Outpatient pediatric oesophagoscopy using a flexible fibreoptic bronchoscope. Design of an insufflation-aspiration adaptor. International journal of pediatric otorhinolaryngology 1993. link90126-n)