Endoscopic ultrasonography in diagnosis of chemical esophageal burn and prediction of cicatricial stenosis.

Objective: To analyze the role of endoscopic ultrasonography (EUS) in predicting the risk of cicatricial stenosis after chemical esophageal burn.

Material And Methods: A retrospective study included 56 patients with chemical esophageal burn grade III/IV. Primary endoscopy was performed upon admission. To estimate lesion of muscular layer of esophageal wall, we performed EUS using mini-sensor 20 MHz in 3-5 days after injury. To assess severity of chemical esophageal burn, we used the classification proposed by Volkov S.V. (1997) and supplemented by Pesnya-Prasolova E.A. (2006): grade I - catarrhal damage, grade II - erosive, grade III - ulcerative, grade IV - ulcerative-necrotic damage.

Results: To predict the risk of cicatricial esophageal stenosis, we identified 4 grades (a, b, c, d) of damage to muscular layer of esophageal wall considering EUS data. There was no esophageal stenosis in chemical esophageal burn grade III/IVa and acetic essence poisoning with esophageal burn grade IVb. Cicatricial stenosis occurred in 22 (78.6%) out of 28 patients with chemical esophageal burn grade IV (chemical burn grade IVb following alkalis poisoning and in all patients with chemical burn grade IVc/IVd). The risk of cicatricial stenosis was 9.4 times higher after alkalis burn compared to acetic acid burn.

Conclusion: EUS in chemical esophageal burn grade IV made it possible to identify additional grades (a, b, c, d) of damage to muscular layer of esophageal wall. This increased the effectiveness of endoscopic diagnostics and assessment of the risk of cicatricial esophageal stenosis.