Caustic acid burn of the upper gastrointestinal tract: first use of endosonography to evaluate the severity of the injury.

Judging the severity of an injury after erosions of the upper gastrointestinal tract has been exclusively based on endoscopic inspection. For the first time, we used minimal probe endosonography during initial endoscopy and endoscopical progress observations to improve assessment of injury depth determining the therapy. Nine hours after admitting a patient after acid ingestion, the initial endoscopy and simultaneous endosonography with a 12-MHz minimal endosonographical probe took place. The affected wall sections with macroscopical coagulation necrosis regularly showed a richer echo, broadened first layer, and a low-echo wall edema that had developed under the necrosis. Differences existed between the breadth of the first echo-rich layer and the breadth of the edema below it. The indiscriminability of single wall layers correlated with the intensity of the edema. The initial injury depth was defined based on the depth extension of the wall edema and the discriminability of the layers. In the control examinations, a complete wall edema with limited assessability developed independently of the injury's initial severity. The assessment of injury depth was only possible during a short time span. Differences existed in the regression time of the wall edema. The initial endosonography and diagnostic findings over time showed differences between superficial and deep wall injuries after erosion. In this way, the injury depth could be correctly estimated, thus directly influencing therapy planning.