Foregut caustic injuries: results of the world society of emergency surgery consensus conference

World Journal of Emergency Surgery, Sep 2015

Introduction Lesions of the upper digestive tract due to ingestion of caustic agents still represent a major medical and surgical emergency worldwide. The work-up of these patients is poorly defined and no clear therapeutic guidelines are available. Purpose of the study The aim of this study was to provide an evidence-based international consensus on primary and secondary prevention, diagnosis, staging, and treatment of this life-threatening and potentially disabling condition. Methods An extensive literature search was performed by an international panel of experts under the auspices of the World Society of Emergency Surgery (WSES). The level of evidence of the screened publications was graded using the Oxford 2011 criteria. The level of evidence of the literature and the main topics regarding foregut caustic injuries were discussed during a dedicated meeting in Milan, Italy (April 2015), and during the 3rd Annual Congress of the World Society of Emergency Surgery in Jerusalem, Israel (July 2015). Results One-hundred-forty-seven full papers which addressed the relevant clinical questions of the research were admitted to the consensus conference. There was an unanimous consensus on the fact that the current literature on foregut caustic injuries lacks homogeneous classification systems and prospective methodology. Moreover, the non-standardized definition of technical and clinical success precludes any accurate comparison of therapeutic modalities. Key recommendations and algorithms based on expert opinions, retrospective studies and literature reviews were proposed and approved during the final consensus conference. The clinical practice guidelines resulting from the consensus conference were approved by the WSES council. Conclusions The recommendations emerging from this consensus conference, although based on a low level of evidence, have important clinical implications. A world registry of foregut caustic injuries could be useful to collect a homogeneous data-base for prospective clinical studies that may help improving the current clinical practice guidelines.

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Foregut caustic injuries: results of the world society of emergency surgery consensus conference

Bonavina et al. World Journal of Emergency Surgery Foregut caustic injuries: results of the world society of emergency surgery consensus conference Luigi Bonavina 0 Mircea Chirica 8 Ognjan Skrobic 7 Yoram Kluger 13 Nelson A. Andreollo 12 Sandro Contini 11 Aleksander Simic 7 Luca Ansaloni 10 Fausto Catena 15 Gustavo P. Fraga 12 Carlo Locatelli 14 Osvaldo Chiara 9 Jeffry Kashuk 5 Federico Coccolini 10 Yuri Macchitella 0 Massimiliano Mutignani 6 Cesare Cutrone 3 Marco Dei Poli 4 Tino Valetti 1 Emanuele Asti 0 Michael Kelly 2 Predrag Pesko 7 0 Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School , Piazza Malan 1, 20097 San Donato Milanese (Milano) , Italy 1 Department of Anesthesiology, Papa Giovanni XXIII Hospital , Bergamo , Italy 2 Department of Surgery, Wagga Wagga Hospital , Wagga Wagga , Australia 3 Department of Otolaryngology, Azienda Ospedaliera , Padova , Italy 4 Intensive Care Unit, IRCCS Policlinico San Donato , San Donato Milanese , Italy 5 Department of Surgery, University of Jerusalem , Jerusalem, Rehovot , Israel 6 Department of Endoscopy, Niguarda Hospital , Milan , Italy 7 Department of Surgery, University of Belgrade , Belgrade , Serbia 8 Department of Digestive Surgery, Saint-Louis Hospital , Paris , France 9 Emergency Department, Niguarda Hospital , Milan , Italy 10 General Surgery I, Papa Giovanni XXIII Hospital , Bergamo , Italy 11 University of Parma , Parma , Italy 12 Department of Surgery, University of Campinas , Campinas , Brasil 13 Department of General Surgery, Rambam Health Care Campus , Haifa , Israel 14 Institute of Toxicology, University of Pavia , Pavia , Italy 15 Emergency Surgery Department, Maggiore Parma Hospital , Parma , Italy Introduction: Lesions of the upper digestive tract due to ingestion of caustic agents still represent a major medical and surgical emergency worldwide. The work-up of these patients is poorly defined and no clear therapeutic guidelines are available. Purpose of the study: The aim of this study was to provide an evidence-based international consensus on primary and secondary prevention, diagnosis, staging, and treatment of this life-threatening and potentially disabling condition. Methods: An extensive literature search was performed by an international panel of experts under the auspices of the World Society of Emergency Surgery (WSES). The level of evidence of the screened publications was graded using the Oxford 2011 criteria. The level of evidence of the literature and the main topics regarding foregut caustic injuries were discussed during a dedicated meeting in Milan, Italy (April 2015), and during the 3rd Annual Congress of the World Society of Emergency Surgery in Jerusalem, Israel (July 2015). Results: One-hundred-forty-seven full papers which addressed the relevant clinical questions of the research were admitted to the consensus conference. There was an unanimous consensus on the fact that the current literature on foregut caustic injuries lacks homogeneous classification systems and prospective methodology. Moreover, the non-standardized definition of technical and clinical success precludes any accurate comparison of therapeutic modalities. Key recommendations and algorithms based on expert opinions, retrospective studies and literature reviews were proposed and approved during the final consensus conference. The clinical practice guidelines resulting from the consensus conference were approved by the WSES council. Conclusions: The recommendations emerging from this consensus conference, although based on a low level of evidence, have important clinical implications. A world registry of foregut caustic injuries could be useful to collect a homogeneous data-base for prospective clinical studies that may help improving the current clinical practice guidelines. - Introduction A wide variety of chemical agents including mineral and organic acids and alkalis, oxidizing agents, denaturants, hydrocarbons and other chemicals may cause corrosive injuries. Although the mechanism, the severity, and the timing of the injury may vary, all these substances cause damage to living tissue on contact. Accidental or intentional ingestion of corrosive substances cause lifethreatening injuries of the upper digestive tract. The degree of injury is related to the concentration, amount, viscosity, and duration of exposure to the caustic agent. The large majority of caustic agents are liquids. Strong acids and alkali are readily available as household cleaners. Lye is a generic term for the alkali used to make soap, either potassium hydroxide or sodium hydroxide. Acids cause coagulation necrosis, whereas alkali combine with tissue proteins and cause liquefaction necrosis which penetrates deep into tissues. Concentrated alkali ingestion may lead to more serious injury and complications by penetrating tissues and leading to full-thickness damage of the esophageal/gastric wall. Liquid household bleach, although often report (...truncated)


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Luigi Bonavina, Mircea Chirica, Ognjan Skrobic, Yoram Kluger, Nelson Andreollo, Sandro Contini, Aleksander Simic, Luca Ansaloni, Fausto Catena, Gustavo Fraga, Carlo Locatelli, Osvaldo Chiara, Jeffry Kashuk, Federico Coccolini, Yuri Macchitella, Massimiliano Mutignani, Cesare Cutrone, Marco Poli, Tino Valetti, Emanuele Asti, Michael Kelly, Predrag Pesko. Foregut caustic injuries: results of the world society of emergency surgery consensus conference, World Journal of Emergency Surgery, 2015, pp. 44, 10, DOI: 10.1186/s13017-015-0039-0