Is the Emergent Endoscopy Necessary for the Patients Who Ingested Liquid Household Bleach Containing Sodium Hypochlorite?

ABSTRACT

PURPOSE: In the emergency department (ED), there are many cases of routine emergent endoscopic evaluation for patients who ingest liquid household bleach containing sodium hypochlorite. Many researchers have recommended endoscopic evaluation for caustic injury, but there is much controversy over the indication for emergent endoscopy. Because the clinical course of patients who ingest sodium hypochlorite is commonly mild, we investigated the necessity for routine emergent endoscopy. METHODS: We included patients who visited the ED due to ingestion of liquid bleach containing sodium hypochlorite during the 4 years from June 2001 to May 2005. We retrospectively reviewed the demographic characteristics, ingested amount, symptoms and signs, disposition, and endoscopic results. We also tried to find relationships between the variables and the final endoscopic results. RESULTS: Of the 63 patients included in this study, 47 underwent emergent endoscopy in the ED. The endoscopic results were Grade 1 in 31 patients, Grade 2a in 13, Grade 2b in 2, and Grade 3a in 1. Clinically significant results were observed in only 3 (6.4%) cases. The symptoms and signs was not related to the endoscopic results, but diluted ingestion and the amount of ingestion (<100ml) were significantly related to the endoscopic severity. CONCLUSION: The indications for emergent EGD (esophagogastroduodenoscopy) for caustic injury were discussed. In almost all cases, however, the clinical course of the patients ingesting the sodium hypochlorite was not significant. If the patient ingests a small amount of diluted liquid bleach, < 100 ml, and has few symptoms and signs, we recommend follow up in the outpatient department, which will reduce unnecessary emergent endoscopy.