A recent study (A Singh et al. JPGN 2019; 68: 824-8) provides a descriptive retrospective review of a single center experience with detergent pods (a.k.a. laundry pods or dishwater pods). There is very little published in this area and no clear consensus on management.
For me, the most interesting finding in the study is the discrepancy between the ENT service which only did a direct laryngoscopy-bronchoscopy (DLB) in 6 of 23 (26%) ingestions compared with 21 of 23 (91%) EGD rate among patients who presented to the GI service.
- Of those undergoing an EGD, 76% were normal; abnormal findings (edema, erythema or ulceration) were present in 24% (though figure 4 suggests erythema in 28%). Ulceration was noted in 14%.
- In the DLB cohort (n=6), 33% were normal and 67% were abnormal.
Unfortunately, this report has a lot of limitations:
- It did not provide any information regarding long-term effects (if any were present)
- It did not provide much guidance in determining whether an EGD is worthwhile. The authors did note that patients with oral injuries were more likely to have an abnormal EGD. 80% of patients with positive oropharyngeal findings had an abnormal EGD compared with 20% with a normal oropharyngeal exam.
- In the discussion, the authors reference a study which reported esophageal injury in only 0.1% of cases (Davis et al. Pediatrics. 2016 May;137(5). pii: e20154529. doi: 10.1542/peds.2015-4529. Pediatric Exposures to Laundry and Dishwasher Detergents in the United States: 2013-2014). There were two deaths in this study.
My take: This would have been a good report to have an associated commentary/expert opinion. Even if an EGD is abnormal, this does not mean that the EGD was needed. The bigger question is how often an EGD would improve management. Given the lack of specific treatments, it is likely that an EGD should be reserved for severe cases –which could include the following:
- intentional ingestions
- significant oropharyngeal burns
- food refusal
- drooling/difficulty managing secretions
Related blog post: New caustic danger from detergent pods
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