Cost-Effectiveness of the Sucralfate Technetium 99m isotope Labelled Esophageal Scan to Assessesophageal Injury in Children after Caustic Ingestion

Ties Lukas Janssen , Monique Van Dijk, Arjan Sebastiaan Van As*, Alastair John Ward Millar , Alp Numanoglu and Anita Brink

Cost-Effectiveness of the Sucralfate Technetium 99m isotope Labelled Esophageal Scan to Assess esophageal Injury in Children after Caustic Ingestion

Ingestion of caustic material by children continues to be a significant problem in developed countries.1
Over 200,000 of such cases were reported in the United States in 2009
alone,2
of which 807 required hospitalization.3
Accurate figures on the incidence of this type of
injury in developing countries are not available however the large number of children requiring
esophageal replacement for caustic injury indicates that this is a serious public health problem.

The extent of the esophageal injury after ingestion of caustic substances has been
determined using different methods, such as traditional radiology, CT-scan, ultrasound and endoscopy

In 2001, Millar et al. showed the accuracy of a 99mTc-labelled sucralfate scan in de-tecting esophageal injury after ingestion of caustic substances.6
When sucralfate comes into contact with damaged tissue it adheres. This has been part of its efficacy in the treatment of peptic
ulcer. Sucralfate mixed with radioactive technetium 99m will
bind to the damaged area, which will then be visible as a hot
spot on the scan.6
It has been our practice since validating the
sensitivity of the sucralfate scan to perform a scan as a screening
investigation after a child has been admitted with a history of
caustic ingestion with or without clinical evidence of buccal or
pharyngeal mucosal injury. Endoscopy to determine the extent
of the damage was only performed after a positive scan. If the
sucralfate scan showed no sucralfate adherence to the esophageal mucosa endoscopy was not performed since the negative
predictive value of the sucralfate scan has proven to be 100%

Emerg Med Open J. 2015; 1(1): 17-21. doi: 10.17140/EMOJ-1-105

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