A prospective randomized controlled trial of omeprazole for preventing esophageal stricture in grade 2b and 3a corrosive esophageal injuries.

OBJECTIVES: Esophageal stricture is a significant complication of grade 2b and 3a esophageal injuries and causes much patient suffering. Preventing strictures would be beneficial to patients but there are currently no proven effective drugs. This study aimed to evaluate the effect of omeprazole for preventing esophageal stricture in adults with grade 2b and 3a corrosive esophageal injuries. METHODS: This study was an open single-center prospective randomized controlled trial that took place from April 2018 to January 2020. Patients were randomized to standard treatment or 80 mg/day intravenously × 3 days followed by 40 mg/day orally for 4 weeks. They were endoscoped at baseline and 4 weeks post discharge. Strictures were confirmed radiologically. RESULTS: 20 patients were enrolled: 15 with grade 2b and five with grade 3a injuries. Standard care and omeprazole groups numbered 10 each. At 1 month, seven and two patients developed strictures in the standard and omeprazole groups, respectively, p = 0.024, for a risk reduction of 71.4%. CONCLUSIONS: Omeprazole reduced the risk of short-term developing esophageal strictures following grade 2b and 3a corrosive esophageal injuries. Larger studies are needed to reconfirm this finding. Thai Clinical Trials Registry (TCTR) number TCTR20190504001.

Anthropometric parameters as a predictor for abdominal wall thickness in a patient with gastrostomy.

BACKGROUND: Enteral feeding tubes play essential roles in clinical management and nutritional support. Knowledge of the abdominal wall is beneficial in surgical practice and safe for gastrostomy. Anthropometric parameters are currently used for clinical assessment in many clinical applications. That might be beneficial if we applied anthropometric measurement for thickness prediction of the abdominal wall to the schedule of patients' gastrostomy care. This study aimed to evaluate the anthropometric parameters of abdominal wall thickness (AWT). METHODS: We conducted a cross-sectional study with anthropometric parameters and CT-measured anterior AWT were assessed and analyzed. RESULTS: The data are collected from January 2020 to March 2021. Arm circumference and body mass index were strongly correlated with AWT at left upper quadrant area and anterior AWT at middle area. The data was created in an TAWT (Thammasat AWT) chart to represent body parameters to AWT. CONCLUSIONS: Arm circumference is related to AWT. A TAWT chart is designed to help medical personnel evaluate the thickness of the abdominal wall and could guide estimating the gastrostomy tube length.

WITHDRAWN: Argon plasma coagulation therapy for acute non-variceal upper gastrointestinal bleeding.

BACKGROUND: Endoscopic treatment is recommended for initial hemostasis in non-variceal upper gastrointestinal bleeding. Many endoscopic hemostatic devices are used. Argon Plasma Coagulation (APC) is an alternative. OBJECTIVES: This study reviews all available literature to access the efficacy of APC compared to other endoscopic therapies in the control of acute non-variceal upper GI hemorrhage. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4 2003), MEDLINE 1966 to December 2003, EMBASE 1980 to December 2003, Web of Science for SCISEARCH (1980 to December 2003), BIOSIS (1985 to December 2003), and the National Research Register Issue 4 2003. We also handsearched abstracts from conference proceedings of the United European Gastroenterology Week and Digestive Disease Week. SELECTION CRITERIA: Randomized, controlled trials of APC compared with other endoscopic hemostasis interventions in the treatment of non-variceal upper gastrointestinal bleeding. DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and independently extracted data. MAIN RESULTS: Two trials involving 121 people were included. There was no common intervention to pool. One trial compared APC to heat probe, another trial compared APC to injection sclerotherapy. There was no significant difference between groups in either of these trials. AUTHORS' CONCLUSIONS: On the basis of the two randomised controlled trials identified in this review, there is no evidence to suggest that APC is superior to other endoscopic therapies. Further randomised controlled trials are needed.

Risk Factors for Esophageal Stricture in Grade 2b and 3a Corrosive Esophageal Injuries.

BACKGROUND AND PURPOSE: Publications document the risk of developing esophageal stricture as a sequential complication of esophageal injury grades 2b and 3a. Although there are studies describing the risk factors of post-corrosive stricture, there is limited literature on these factors. The aim of this study was to evaluate the different factors with post-corrosive esophageal stricture and non-stricture groups in endoscopic grades 2b and 3a of corrosive esophageal injuries. METHODS: Data were retrospectively analyzed in the patients with esophageal injury grades 2b and 3a between January 2011 and December 2017. RESULTS: One hundred ninety-six corrosive ingestion patients were admitted with 32 patients (15.8%) in grade 2b and 12 patients (6.1%) in grade 3a and stricture was developed in 19 patients (61.3%) with grade 2b and in 10 patients (83.3%) with grade 3a. The patients' height of the non-stricture group was greater than that of stricture groups (2b stricture group, 1.58 ± 0.08 m; 2b non-stricture group, 1.66 ± 0.07 m; p < 0.004; 3a stricture group, 1.52 ± 0.09 m; 3a non-stricture group, 1.71 ± 0.02 m; p < 0.001). Omeprazole was more commonly used in the non-stricture than stricture group (26.3% in the 2b stricture group, 69.2% in the 2b non-stricture group, p = 0.017; 50% in the 3a stricture group, 100% in the 3a non-stricture group, 1.71 ± 0.02 m, p = 0.015). CONCLUSIONS: The height of patients may help to predict the risks and the prescription of omeprazole may help to minimize the risks of 2b and 3a post-corrosive esophageal stricture.

Initial signs and symptoms as prognostic indicators of severe gastrointestinal tract injury due to corrosive ingestion.

Corrosive ingestion can produce severe upper gastrointestinal tract injury with long-lasting suffering and even death. Early assessment of the extent of damage is important, not only for treatment, but also for hospitalization. We did a prospective study to determine the prognostic value of initial signs and symptoms as indicators of the degree of gastrointestinal injury. We found that drooling saliva, buccal mucosa burn, and white blood cell count were significant independent predictors. The simple chart, "Med-TU chart," has been developed. We consider it to be a useful tool for emergency physicians who evaluate patients with corrosive ingestions.

A retrospective study of anastomotic leakage between patients with and without vascular enhancement of esophageal reconstructions with colon interposition: Thammasat University Hospital experience.

BACKGROUND: Anastomotic leakage is a common complication after operative reconstruction with colon interposition in corrosive esophageal injury patients. Because the underlying causes are ischemic in nature, vascular enhancement would resolve this complication. OBJECTIVE: To compare the incidence of anastomotic leakage between patients with and without vascular enhancement of esophageal reconstructions with colon interposition. MATERIALS AND METHODS: This is a retrospective comparative study between patients with and without vascular enhancement during corrosive esophageal reconstructions with colon interposition in Thammasat University Hospital from January 2004 to December 2012. RESULTS: Twenty-five adult patients who received esophageal reconstructions with colon interposition for corrosive esophageal injury were included in this study. Eleven of these patients also received vascular enhancement (classified as the "with vascular enhancement" group) during the reconstruction, whereas the remaining 14 patients did not (classified as the "without vascular enhancement" group). There was no significant difference in baseline characteristics of the patients between the two groups (i.e., sex, age, and preoperative hematocrit and serum albumin levels). There was also no significant difference in the leakage rate between the two groups: 35.7% (5/14) and 9% (1/11) in the without and with vascular enhancement groups, respectively (p = 0.180). However, in the "with vascular enhancement" group, the operative time was significantly longer (7.8 hours vs. 6.4 hours; an additional 1.4 hours), whereas length of hospital stay was shorter (18.3 days vs. 28.1 days; reduced by 9.8 days) compared with the other group. CONCLUSIONS: Patients who received vascular enhancement along with colon interposition had a lower incidence of anastomotic leakage; however, there was no significant difference between the two groups in this study. Thus, further studies with a large sample size should be conducted in this regard.

Is there a difference between the management of grade 2b and 3 corrosive gastric injuries?

OBJECTIVE: To evaluate the differences between treatment of patients with grade 2b or grade 3 gastric injuries. SETTING: A University Hospital. DESIGN: Retrospective review. PATIENTS: Thirty patients who ingested caustic agents over a 5 year period were examined by endoscope within 48 hours of injury. RESULT: Twenty one patients ingested strong acid or alkali. Among these patients, five had grade 2b, and two had grade 3 injuries. In both cases of grade 3 injuries, extensive surgical approach was initially performed, then delayed jejunal and colonic interpositions were done. On the other hand, one 2b patient had exploratory laparotomy, while others were treated conservatively. All 2b patients had satisfactory conditions during the initial follow-ups. Three patients were healthy during the 11, 16, and 44 months follow-up, one developed chronic gastritis at 5 months and one patient failed to follow-up. CONCLUSION: Early and aggressive extensive removal of necrotic tissue is necessary and can certainly increase the survival. There is on going controversy in the management of injuries less than grade 3. Grade 2b gastric injury patients can be managed conservatively.

Clinical features of corrosive ingestion.

OBJECTIVE: To study the clinical presentation after corrosive ingestion. SETTING: A University Hospital. DESIGN: Prospective descriptive study. PATIENTS AND METHOD: Corrosive ingestion patients were studied, from July 2000 to December 2002. Reasons for ingestion, symptoms, physical findings and routine investigations were recorded in a standard form. Data analysed using the descriptive statistical method. RESULTS: There were 73 patients, 55 women and 18 men, median age 22 years, 48 (65.8%) of whom had ingested strong acid, 3 (4.1%) ingested strong alkali. Suicidal gesture was the most common reason for ingestion (89.2%). The amount of ingestion was less in accidental cases. Symptoms of nausea/vomiting, drooling and abdominal tenderness were associated with the amount of ingestion, while severity of lips, buccal mucosa and palate injuries was significantly related with strong corrosive agents (p < 0.05). Leucocytosis was found in patients who had symptoms of drooling, hoarseness, stridor and signs of mucosal slough or superficial ulcers (p < 0.05). Four required surgery. Two of them had esophago-gastrectomy. Twenty-one patients were followed-up, with the median follow-up time of 11 (1-28) months. One patient died from HIV infection. The rest were normal. CONCLUSION: Drooling and oral mucosal slough or ulcers were significant findings and were related to the amount and strength of the corrosive substance ingested, respectively. To meet the goal of a holistic approach, attention must also be given to psychiatric management, and surgeons should provide a supportive role.