Optimizing triage in acute caustic ingestion: Choosing between endoscopy and computed tomography

Acute caustic ingestion is a medical emergency that can cause a wide spectrum of gastrointestinal injuries, making timely and accurate triage essential. Early esophagogastroduodenoscopy, performed within 12-24 hours, remains the gold standard for assessing mucosal injury but cannot evaluate transmural or extra-luminal involvement. Computed tomography (CT) has been increasingly used as a valuable alternative tool, providing cross-sectional assessment of the gastrointestinal wall and surrounding tissues and enabling early detection of complications such as necrosis, perforation, mediastinitis, and peritonitis. However, CT carries its own limitations, including radiation exposure, variable acquisition protocols, and the lack of standardized grading systems. Therefore, the optimal choice between esophagogastroduodenoscopy and CT remains an area of ongoing research, and in practice, the two modalities are best viewed as complementary rather than mutually exclusive.