2017-18 HSC Section 3 Green Book

Sylvester MJ, Chung SY, Guinand LA, et al. Arterial ligation versus embolization in epistaxis management: counterintuitive national trends. Laryngoscope . 2017; 127(5):1017-1020. EBM level 3..............................................................................202-205 Summary : This study used the National Inpatient Sample database to compare frequency of ligation versus embolization used in the treatment of patients admitted with a primary diagnosis of epistaxis. Ligation management was associated with decreased cost of care and shorter length of stay. C. Caustic ingestion Aronow SP, Aronow HD, Blanchard T, et al. Hair relaxers: a benign caustic ingestion? J Pediatr Gastroenterol Nutr . 2003; 36(1):120-125. EBM level 4...........................206-211 Summary : A retrospective cohort of 96 patients who ingested a high pH substance and underwent endoscopy showed that despite the high pH of these products, no clinically significant esophageal or gastric mucosal injuries and no long-term sequelae were identified. Kochhar R, Ashat M, Reddy YR, et al. Relook endoscopy predicts the development of esophageal and antropyloric stenosis better than immediate endoscopy in patients with caustic ingestion. Endoscopy . 2017; 49(7):643-650. EBM level 4.......................212-219 Summary : This article is a retrospective cohort study of 62 patients with caustic ingestion comparing endoscopic findings on day 1 vs. day 5 after injury. Adverse outcomes, specifically stricture, were then examined in relation to these endoscopic findings and the ability to predict an outcome based on endoscopy at different time points. Summary : This article presents a review of current literature for updates in the treatment of caustic ingestion. Findings suggest that it may be safe to advance the endoscope beyond the first circumferential burn to allow for a more complete assessment of extent of injury, a 3-day course of high-dose methylprednisolone might reduce the occurrence of esophageal stricture formation, balloon dilatation has been shown to be as effective as other bougienage techniques with lower risk of perforations, esophageal dilatation can be safely performed as early as 5 to 15 days after initial ingestion and may decrease risk for long-term stricture formation, and the use of adjunctive treatment, such as topical mitomycin C and esophageal stents, shows promise in reducing the reoccurrence of stricture formation after dilatation. Shub MD. Therapy of caustic ingestion: new treatment considerations. Curr Opin Pediatr . 2015; 27(5):609-613. EBM level 4...........................................................220-224