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

Table 2 Computed tomography grading of acute caustic injury as per the Ryu and Chirica classification

Grade	CT findings	Clinical implication
Ryu classification
Grade 1	No definite swelling of esophagus wall (< 3 mm, within normal limit)	No injury
Grade 2	Edematous wall thickening (> 3 mm) without periesophageal soft tissue infiltration	Usually mild injury; often managed conservatively; low risk of complications
Grade 3	Edematous wall thickening with periesophageal soft tissue infiltration plus well-demarcated tissue interface	Moderate injury; risk of stricture formation; close monitoring required
Grade 4	Edematous wall thickening with periesophageal	Severe injury; high risk of progression; surgical evaluation considered
	Soft tissue infiltration plus blurring of the tissue
	Interface or localized fluid collection around esophagus or descending aorta
Chirica classification
Grade 1	Normal appearing GI tract	No injury
Grade 2	Wall edema, surrounding soft tissue inflammation and increased postcontrast wall enhancement	Mild to moderate risk of injury; moderate to high risk of stricture formation
Grade 3	Transmural necrosis, as shown by the absence of postcontrast wall enhancement with surrounding soft tissue inflammation	Moderate injury; risk of stricture formation; close monitoring required

CT: Computed tomography; GI: Gastrointestinal.