Endoscopic and Therapeutic Profile of Pediatric Patients with Caustic Ingestion: A Seven-Year Experience at a High-Complexity Pediatric Hospital

Abstract

Introduction. Ingestion of caustic substances in children can cause esophagogastric injuries with significant sequelae, particularly esophageal stenosis. Early upper gastrointestinal endoscopy allows for grading the injury according to the Zargar endoscopic classification and guiding follow-up.

Objective. To describe the endoscopic and therapeutic profile of pediatric patients who ingested caustic substances and were treated between 2018 and 2024 at a referral pediatric hospital.

Materials and Methods. Observational, retrospective, and descriptive study. Patients under 14 years of age who underwent emergency upper gastrointestinal videoendoscopy due to suspected or clinically confirmed ingestion of caustic substances (January 2018–December 2024) were included. Lesions were classified according to the Zargar endoscopic classification (0, I, IIa, IIb, III). Gastric involvement and the need for treatment (dilations, intralesional triamcinolone injection, or surgery) were recorded.

Results. A total of 161 patients were analyzed (mean age: 3 years; 65.8% male). At the initial endoscopy, no lesions were detected in 60 patients (37.3%); Zargar I was observed in 39 (24.2%), Zargar II in 53 (32.9%), and Zargar III in 9 (5.6%). Gastritis was noted in 25 cases (15.5%), mainly in Zargar II–III lesions. Esophageal dilations were required in 32 patients (19.8%): 25/53 (47.2%) with Zargar II lesions and 7/9 (77.8%) with Zargar III lesions. Five patients (3.1%) developed refractory esophageal stenosis (dilation intervals ≤21 days). Fifteen patients received intralesional triamcinolone, although no conclusive benefit was observed in reducing the number of dilation sessions. Two patients (1.2%) required surgical treatment (gastric pull-up).

Conclusions. In this series, Zargar II lesions were the most common among clinically significant injuries and were associated with a substantial need for esophageal dilation. Early endoscopic stratification allows anticipation of the need for intervention and follow-up. In our experience, intralesional triamcinolone did not demonstrate a conclusive benefit.