CONSERVATIVE VERSUS SURGICAL INTERVENTIONS FOR PATIENTS WITH GRADE 2B CORROSIVE INGESTION

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CONSERVATIVE VERSUS SURGICAL INTERVENTIONS FOR PATIENTS WITH GRADE 2B CORROSIVE INGESTION

Journal Title: World Journal of Pharmaceutical Research - Year 2019, Vol 8, Issue 5

Abstract

Introduction: Chemical burns caused by ingestion of caustic substances, such as acids and alkalis, occur in about two-thirds of cases of accidental ingestion of these substances. Supportive treatment is performed in the Grade I and for Grade II and III explorative laparotomy is done that there is a risk of misdiagnosis and inappropriate treatment of such patients in endoscopy and surgery. In addition to acute phase problems, these types of injuries can cause chronic and complications, such as increasing the chance of malignancy and stenosis and dysphagia. Therefore, timely treatment of these patients can be effective in improving their prognosis. In this case, various therapeutic methods, including preservative and non-invasive treatments, or surgical treatments are used, the selective method depends on the severity of the initial injury, the underlying conditions of the patients, and the complications. Understanding the pathophysiology of the damage can also help in choosing a more effective treatment. Objective: Comparison of the results of medical treatment and surgical intervention in patients with Grade 2b esophagial burn due to ingestion of causative agent and identifying the method with the highest efficacy in order to be able to improve the treatment and reduce side effects by appropriate planning. Introduction: Chemical burns caused by ingestion of caustic substances, such as acids and alkalis, occur in about two-thirds of cases of accidental ingestion of these substances. Supportive treatment is performed in the Grade I and for Grade II and III explorative laparotomy is done that there is a risk of misdiagnosis and inappropriate treatment of such patients in endoscopy and surgery. In addition to acute phase problems, these types of injuries can cause chronic and complications, such as increasing the chance of malignancy and stenosis and dysphagia. Therefore, timely treatment of these patients can be effective in improving their prognosis. In this case, various therapeutic methods, including preservative and non-invasive treatments, or surgical treatments are used, the selective method depends on the severity of the initial injury, the underlying conditions of the patients, and the complications. Understanding the pathophysiology of the damage can also help in choosing a more effective treatment. Objective: Comparison of the results of medical treatment and surgical intervention in patients with Grade 2b esophagial burn due to ingestion of causative agent and identifying the method with the highest efficacy in order to be able to improve the treatment and reduce side effects by appropriate planning. Methods: In this cohort observation study, 50 patients with grade 2b burns of esophagus due to caustic ingestion in Loghman Hospital of Shahid Beheshti University were selected and evaluated. Information about them is entered with a checklist containing variables including age, gender, type of substance, associated illness, hospital admissions and therapeutic outcomes including stenosis, dysphagia, fistula and mortality. Patients are divided into two groups: A for medical treatment and B for surgical intervention. Patients treated with these two methods are followed up and based on clinical examination and, if needed, imaging and endoscopy, the incidence of burn complications is determined. Finally, data analysis is performed using SPSS software version 24. Chi-Square and Fisher test and independent t test are used to compare the results and the significance level is considered 0.05. Results: The average age in group A was 23.4±6 and in group B was 22.7±3.4. In group A the sex ratio was 1.7:1 (for Male:Female) and in group B was 2.1:1, which did not have a significant difference. In group A, 11 (44%) were damaged by alkali and 14 (56%) were damaged by acid. For group B, these results were 15 (60%) and 10 (40%) respectively, Which did not have significant difference. The frequencies of patients' re-admissions were almost the same during the treatment and did not differ significantly. In group A, there was one case of esophageal stricture, one case of dysphagia and one case of esophageal fistula with no mortality In group B, these results were two cases of stricture, four cases of dysphagia and three cases of fistula with two cases of mortality. Conclusion: According to the findings of this study, it is suggested that laparotomy is not recommended at least in classes 2a and 2b, but more studies are needed to confirm this. In these patients, in the absence of clear clinical evidence of mediastinitis or peritonitis, and only on the basis of endoscopic grading, medical treatment, serial follow up and paraclinical test should be done and Appropriate treatment should be done if any complications occur.

Authors and Affiliations

Dr. Esmaeil Hajinasrollah

Keywords

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