Optimising Symptom-Based Endoscopy Decision Making in Paediatric Corrosive Ingestion

We were very interested in the study by Ateş et al. [1] called ‘Corrosive substance ingestion: When to perform endoscopy?’ that was published in your journal. The authors present a useful symptom-based algorithm for deciding whether a child who has ingested corrosive substances needs an endoscopic evaluation. This is a big step forward for evidence-based emergency paediatric care.

It is especially interesting that the proposed algorithm focuses on hypersalivation and dysphagia as the main signs for endoscopy. This approach is in line with current research that shows that clinical symptoms are good indicators of serious oesophageal injury [2]. The fact that 27.9% of patients had no symptoms and no complications strongly supports the safety of conservative management in carefully chosen cases.

Recent studies have shown that symptom-based approaches are even more useful. For example, the DROOL score (Drooling, Reluctance, Oropharynx, Others, Leukocytosis) has been shown to be very good at predicting oesophageal injuries, with a sensitivity of 94.4% and a specificity of 76.9% [3]. This scoring system works well with the algorithm suggested by Ateş et al. and gives doctors more objective criteria to use when making decisions.

This study has real-world effects that go beyond just caring for one patient. In places where resources are limited and endoscopic capabilities may be limited, the ability to safely avoid unnecessary procedures while still providing high-quality care is especially useful. The authors' algorithm could cut down on unnecessary endoscopies by 63%, which would be a big improvement in resource use without putting patients at risk [4].

We do, however, think that some areas need more thought. First, we should pay special attention to how well the algorithm works in very young children (under 2 years) who may not be able to clearly show symptoms. Second, it would be helpful to go into more detail about the role of chest x-rays and how they fit into the decision-making process, especially when the clinical presentation is unclear.

Long-term outcomes and the growth of oesophageal strictures are also very important things to think about. The study is mostly about acute management; however, follow-up protocols for patients who were treated conservatively could make this algorithm more useful in real life [5].

In conclusion, Ateş et al. have given us a useful, evidence-based way to deal with a difficult clinical situation. Their symptom-based algorithm is a big step forward in how to handle corrosive ingestion in children. It could help make better use of resources while keeping safety standards high. We suggest that this algorithm be tested in larger, multicentre groups to further prove its usefulness in the clinic.

The authors have nothing to report.

The authors have nothing to report.

The authors declare no conflicts of interest.