Added Value of Positive Intraluminal Contrast CT over Fluoroscopic Examination for Detecting Gastrointestinal Leakage after Gastrointestinal Surgery

Abstract

We tried to evaluate the added value of positive intraluminal contrast CT over fluoroscopy to detect anastomotic leakage after gastrointestinal surgery. 141 GI surgery patients with both fluoroscopic examinations and CT were included. Two radiologists reviewed fluoroscopic images with/without CT for determining anastomotic leakage on 5-point confidence scale and grading the leakage on 4-point grading system. Duration of hospital stay and type of treatment were recorded. Radiologists’ diagnostic performances for determining leakage were compared using the ROC analysis and inter-observer agreement was analyzed. 53 patients had GI leakage. When CT were added to fluoroscopic images, the AUC values significantly increased for both reviewers (from 0.859 to 0.942 for reviewer 1, P = 0.001; from 0.757 to 0.879 for reviewer 2, P = 0.002). Interobserver agreement between the two reviewers for the presence of leakage was excellent and improved with the addition of CT (weighted-kappa value, 0.869 versus 0.805). Postoperative intervention was more frequently performed (P < 0.001) and mean duration of postoperative hospital stay was significantly longer in patients with leakage (45 days versus 27 days) (P = 0.003). Through this, positive intraluminal contrast CT has an added value over fluoroscopic examination for detecting GI leakage in GI tract surgery patients, increasing AUC values and improving interobserver agreement.