Nouve l le condui te t h e r a p e u t i q u e dans les a t te in tes cor ros ives du t rac tus digest i f super ieur

J. DI COSTANZO, M. NOIRCLERC, J. JOUGLARD, A. GAUTHIER

Unit~ de soins intensiJs d'hdpato-gastroentdrologie

HOpital Sainte-Marguerite, 13009 Marseille (France)

A new therapeutic approach to corrosive burns of the upper gastrointestinal tract

Une nouvelle conduite th6rapeutique impli- quant la coordination d'un centre d'urgences toxicologiques, d'une unit6 de soins intensifs digestifs et d'un service de chirurgie thoraci- que, a 6t6 appliqu6e ~t 72 patients cons6cutifs ayant absorb6 un produit corrosif. Cette conduite a 6t6 bas6e sur 3 points principaux : 1) Bilan des 16sions par fibroendoscopie pr~- coce (64 cas). 2) Protection imm6diate des brfilures digestives av6r6es (stades II et III) par nutrition parentdrale totale hypercalorique (31 cas), Alimentation orale normale pour les brfilures mineures (stade I: 23 cas). 3) Traite- ment des s6quelles 6ventuelles par chirurgie r6paratrice en phase cicatricielle confirm6e par radiocin6ma et fibroscopie. Cette conduite excluait l'emploi syst6matique de corticoides, d'antibiotiques, de sondes nasogastriques et de dilatations oesophagiennes.

Les r6sultats sont les suivants : a) La cica- trisation est respectivement obtenue pour les

stades I, II et III en 8, 20 et 90 jours quel que soit le produit absorb& b) La fr6quence des complications 6volutives (h6morragies, perfora- tions, st6noses) est consid6rablement diminu6e. c) Aucune complication n'est apparue apr6s chirurgie rdparatrice, d) La mortalit6 globale est faible (5 cas).

L'analyse des r6sultats permet de penser qu'une nutrition parent6rale exclusive hyper- calorique pr4coce en l'absence de manoeuvres traumatisantes am61iore effectivement le pro- nostic g6n4ral des brfilures graves du T.D.S. par des agents caustiques.

Stade 1 : Congestion - hyperh6mie.

Stade 11: UlcErations; n6crose limit6e; h6morragies peu abondantes.

Stade I11 : N6crose 6tendue; h6morragies abondantes.

A new therapeutic approach based on a co- ordinated management applied by a Poisons Center, an Intensive Care Unit of hepato-gas- troenterology, and a Surgical Thoracic Center was given to 72 consecutive patients after in- gestion of corrosive products.

This management has been based essentially on 3 major points : 1) Definition of extent of upper gastrointestinal (U.G.I.) lesions by im- mediate fibro-endoscopy. 2) Immediate pro- tection of the U.G.I. tract by total parenteral nutrition (T.P.N.) at a high caloric level in

Tir6s h part: J. D1 COSTANZO, H6pital Sainte- Marguerile. 13009 Marseille (France).

Mots-cl~s: O~sophage, estomac. L6sions corrosives. Endoscopic. Traitements m~dical et chirurgical.

Key-words : Oesophagus, stomach. Corosive injuries. Endoscopy. Medical and surgical managements.

Acta Endoscopica et Radiocinematographica Tome VII - N o 4 - 1977 317

cases with serious burns (stages II and III): 31 cases. Normal oral nutrition for minor burns (23 cases). 3) Reparative surgical procedures for any of the sequelae during fibrosing phase confirmed by radiocinematography and fibro- endoscopy. This management excluded syste- mic use of steroids, antibiotics, nasogastric tu- bes, and oesophageal dilatations by bougirage.

Results are: healing is recpectivly obtained in 8, 20 and 90 days for stages I, lI and Ill burns irrespective of the type of product in- gested, b) The frequency of subsequent compli- cations (bleeding, perforations, stenosis) is appreciably reduced, c) After reconstructive surgery no serious complications occured.

d) The overall mortality stayed at a low level (5 cases).

Analysis of these results leads to the conclu- sion that early total parenteral nutrition at a high caloric level in the absence of local trauma can really improve the general pro- gnosis of severe burns of the U.G.I. tract produced by corrosive products.

Satge I : Congestion - Hyperhaemia.

Stage 11 : Ulcerations; Limited necrosis; little hemorrhages.

Stage III : Wide necrosis ; important hemorr- hages.

318 T o m e V I I - N ~ 4 - 1977 A c t a E n d o s c o p i c a et R a d i o c i n e m a t o g r a p h i c a