2017-18 HSC Section 3 Green Book

▶ Fig. 2 Gastric findings: a on day 1 endoscopy showing edematous gastric folds with islands of blackish mucosa (arrow) in the body of the stomach, graded as 3a; b on day 5 endoscopy showing bile-stained gastric folds with no ulceration and charring, interpreted as grade 2a; c in the distal body on day 1 showing flat mucosa with hemorrhagic spots (arrow) and dark, black mucosal patches (arrowheads), interpreted as grade 3a; d in the antrum on day 5 showing only small patches of submucosal hemorrhage (arrow), graded as 2a, with the remaining mucosa being normal.

Patients with severe injury underwent placement of an endoscopic nasojejunal feeding tube during the relook EGD, as previously described by us [23]. Tube feeding using an homo- genized liquid diet was started once the ileus (if any) had set- tled, in consultation with a dietician. These patients were mon- itored in the hospital for any complications and discharged when stable. The feeding tube (if placed) was removed at 8 weeks, when all of the patients were followed up and EGD was repeated [23]. A barium study was also done to assess the site and extent of esophageal/gastric cicatrization. Patients were assessed for symptoms of dysphagia and vomiting after initia- tion of oral feeds. Management of esophageal cicatrization included endo- scopic dilation, followed by surgery, if the former failed. Indi-

cations for esophagectomy were: stricture length > 6 cm, poor response to dilation, or complications of dilation [23]. Patients with symptomatic gastric outlet obstruction (GOO) were con- sidered for endoscopic balloon dilation, as previously de- scribed by our clinical research group [26]. Patients with cica- trization > 2.5 cm in length and those who failed to respond to dilation were referred for surgery [26]. Outcome measures Based on endoscopic grading on day 1 and day 5, patients were classified as having mild (grade ≤ 2a) or severe (grade ≥ 2b) in- jury. Key outcome variables were: the development of esopha- geal stricture and/or symptomatic antropyloric narrowing, as assessed at 8 weeks.

Kochhar Rakesh et al. Relook endoscopy predicts … Endoscopy

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