A 22-year-old woman ingests strong sulphuric acid in a suicide attempt. Urgent endoscopy within 24 hours shows deep circumferential ulcers involving the mid and distal oesophagus. According to the Zargar endoscopic classification, this injury corresponds to which grade, and what is its significance?
- A Grade 3B, extensive circumferential deep ulceration, carrying a high risk of stricture formation and possible need for surgery ✓
- B Grade 2A, superficial non-circumferential ulceration, with low stricture risk
- C Grade 1, oedema and hyperaemia only, with negligible stricture risk
- D Grade 4, perforation confirmed by free mediastinal air
Explanation
The Zargar classification grades caustic oesophageal injury from Grade 1 (mucosal erythema and oedema), through Grade 2C (superficial, non-circumferential ulceration) and 2B (deep, circumferential or discrete ulceration), to Grade 3C (small scattered areas of deep necrosis) and 3B (extensive deep necrosis). Deep circumferential ulceration as described here is Grade 3B, associated with a very high incidence of oesophageal stricture, increased perforation risk, and possible emergency oesophagectomy if transmural necrosis is present. Grade 4 is not part of the original endoscopic classification.
Reference: Sabiston Textbook of Surgery, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.