Effectiveness of endoscopic diagnosis of caustic esophageal injury

Esophagoscopy (ES) remains the primary diagnostic method for caustic esophageal injury (CEI). However, it does not allow reliable assessment of the depth of injury within the first 24 hours after ingestion. Accurate evaluation of esophageal wall damage is achieved through follow-up endoscopy, including the use of endoscopic ultrasonography (EUS). Objective. To determine the sensitivity of early endoscopic assessment in grading the severity of CEI. Material and methods. A prospective study was conducted involving 258 patients with CEI. Endoscopy were performed at early (<24 h) and delayed (>24 h) stages. The initial severity grade was assessed during early ES; the final grade was confirmed via follow-up ES and EUS. Injury severity was classified according to the Volkov scale (1997), modified by Makarov (2024): grade 1 — catarrhal, grade 2 — erosive, grade 3 — ulcerative, grade 4 (a—d) — ulcerative-necrotic lesions. Results. The grade assigned during early endoscopy differed from that established during follow-up in 27.3% of cases, a statistically significant difference (p<0.001). The sensitivity of early endoscopy for grading CEI was 72.7%. Misclassification of specific grades (1, 2, 3, or 4) occurred 6.3 times more frequently than errors in broader grade ranges (1—2, 2—3, or 3—4): 33% vs. 7% (OR=6.3 [2.1—18.1], p<0.001). Conclusion. Endoscopic diagnosis of caustic esophageal injury should be performed dynamically. The sensitivity of early endoscopy in determining injury grade was 72.7%. Misclassification of exact grades occurred significantly more often than misclassification within adjacent grade ranges.