Computed Tomography Versus Water-Soluble Contrast Swallow in the Detection of Intrathoracic Anastomotic Leak Complicating Esophagogastrectomy (Ivor Lewis)

Strauss, Christiane; Mal, F.; Perniceni, Thierry; Bouzar, N.; Lenoir, S.; Gayet, Brice; Palau, R.

doi:10.1097/sla.0b013e3181c1aeb8

Cited by 76 publications

(64 citation statements)

References 15 publications

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“…Thus, most of the AL in our series (20 of 49; 41%) were diagnosed by CT scan of the chest and abdomen (Fig. 2), in accordance with existing literature [18, 19, 21]. In case of early AL ( n = 11), 3 (27%) patients were diagnosed by suspicious fluid from the peri-anastomotic drain and did not receive further CT scans before initiating revision surgery ( n = 2) or stenting ( n = 1).…”

Section: Discussionsupporting

confidence: 76%

“…In their BestBET study, Jones et al [23] analyzed the data of 1,057 patients to evaluate “the role of routine contrast swallow studies in determining intra-thoracic anastomosis integrity.” Interestingly, the authors suggested “the use of contrast esophagograms as a diagnostic tool in patients for whom the clinical picture suggests a leak.” However, in our opinion and in accordance with Strauss et al [18] and Hogan et al [19] a thoracoabdominal CT scan with oral contrast agent should be performed when AL is clinically suspected to reliably diagnose the AL and further complications (e.g., mediastinitis, abscess, pneumonia etc.). In case of unclear CT results, endoscopy is indicated, as mentioned by some authors [18, 19].…”

Section: Discussionmentioning

confidence: 97%

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Evaluation of Anastomotic Leak after Esophagectomy for Esophageal Cancer: Typical Time Point of Occurrence, Mode of Diagnosis, Value of Routine Radiocontrast Agent Studies and Therapeutic Options

et al. 2017

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Background: Data on the typical time point of occurrence of anastomotic leak (AL) after esophagectomy for esophageal cancer are currently scarce. Therefore, the usefulness of routine radiocontrast agent studies (RRCS) for testing proper healing of the anastomosis after esophagectomy remains unclear. Furthermore, preferred available tools to diagnose postoperative AL and therapeutic options are still under debate. Methods: We present a retrospective analysis of 328 consecutive patients who underwent esophagectomy for esophageal cancer between 2005 and 2015. A RRCS has been performed to date in our center on the fifth postoperative day (POD), before returning to normal oral intake. Results: In total, 49 of 328 patients developed AL after esophagectomy (15%). A total of 11 patients (23%) developed AL before the RRCS and 34 patients (69%) after an unremarkable RRCS; and 4 patients (8%) with AL were diagnosed by RRCS, resulting in overall sensitivity of 16%. The median time point of occurrence of AL was POD 9, the majority of AL (84%) occurred between POD 1 and 19. Computed tomography led to the diagnosis of AL in 41% of patients. The most frequent therapy of AL was stenting in 47% of patients. Endoscopic vacuum therapy was used in 4 patients. Conclusions: The majority of AL occurred within the first 3 weeks after esophagectomy without a typical time point. In our series, RRCS on the fifth POD had a low sensitivity of 16%. Therefore, standardized RRCS and fasting till the examination cannot be generally recommended. In case of clinical suspicion of AL, computed tomography of the chest and abdomen with oral contrast agent should be performed, followed by endoscopy. Endoscopic stent placement remains the standard therapy of AL in our center. Endoscopic vacuum therapy evolves as it is an interesting alternative therapeutic option and can be combined with stenting in selected cases.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 97%

Evaluation of Anastomotic Leak after Esophagectomy for Esophageal Cancer: Typical Time Point of Occurrence, Mode of Diagnosis, Value of Routine Radiocontrast Agent Studies and Therapeutic Options

et al. 2017

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“…Further examinations should be conducted to confirm or to rule out the leakages. CT with oral radiographic contrast such as Iohexol is a feasible and sensitive way to diagnose anastomotic leakage, and repeated examinations in the suspected cases can increase its sensitivity (9,10). The other optional method is the observing presence of methylene blue in pleural effusion or in pus from the thoracic drainage of the patients with suspected leakages after orally intake of methylene blue (11).…”

Section: Discussionmentioning

confidence: 99%

Experiences in the management of anastomotic leakages and analysis of the factors affecting leakage healing in patients with esophagogastric junction cancer

Ding

Mao

et al. 2017

J. Thorac. Dis.

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Background: It was reported in the literatures that the incidence of anastomotic leakage in patients with esophagogastric junction cancer decreased due to application of staplers and closure devices as well as gastric conduit technique in recent years, however, it increased slightly at our center since widely using the above devices and gastric conduit techniques from 2009. The objective of this study was to summarize our experiences in the management of anastomotic leakages and analyze the factors affecting leakage healing in the patients with esophagogastric junction cancer after surgical resection in recent 6 years. Methods: All patients who received surgical resections for esophagogastric junction cancer and diagnosed anastomotic leak at our center between January 2009 and December 2014 were retrospectively analyzed, we also enrolled the patients who had a longer hospital stay (>30 days) as they may develop anastomotic leak. The binary logistic regression in SPSS 16.0 was applied to analyze the factors that may affect leakage healing. Results: Of the 1,815 surgically treated esophagogastric junction cancer patients, 91 cases were diagnosed anastomotic leakage postoperatively. The patients were divided into two groups based on the median leakage healing time (40 days) in this series: fast healing group (37 cases) and slowly healing group (54 cases). All factors that may affect the leakage healing were put into analysis by using binary logistic regression. The results of the analysis showed that leakage size (OR =1.073, P=0.004), thoracic drainage (OR =12.937, P=0.037) and smoking index ≤400 (OR =1.001, P=0.04) significantly affected the healing time, while drinking history (P=0.177), duration of fever after anastomotic leak developed (P=0.084), and hypoproteinemia after leak (P=0.169) also apparently but not significantly affect the healing time.Conclusions: Though many factors may affect leakage healing in the esophagogastric junction carcinoma patients, leakage size, thoracic drainage and smoking index (≤400) are the most important factors affecting the leakage healing. Placement of a chest tube beside the anastomosis area during operation for early identification and control of an anastomotic leak to minimize contamination of the mediastinum is the most important way to promote leakage healing. A chest tube placing into the purulent cavities after the patients experienced leaks is also important for the cure of leakage. More attention should be paid perioperatively to the patients who had a smoking index (≥400) and the patients who suffered fever or hypoproteinemia.

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“…There are several reports regarding the use of endoscopy to observe anastomosis [8,9,10]. Some reports concluded that the sensitivity of endoscopy was higher compared with other examinations or physical symptoms [3].…”

Section: Discussionmentioning

confidence: 99%

Internal Pressure of the Conduit during Endoscopy on the Day after Esophagectomy

Okada

Kawada²,

Nakajima³

et al. 2013

Dig Surg

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Background: In gastrointestinal surgery, anastomosis can result in various complications. Anastomosis is evaluated using classical examinations. The most reliable one is endoscopy, which provides direct information on the anastomosis and conduit. But the influence of endoscopy on anastomosis is uncertain. Methods: The internal pressure of a graft during endoscopy was measured in 36 patients who received esophagectomy, by utilizing the decompression tube which was inserted into the graft during operation. We filled the tube with water and measured the maximum water level in a centimeter water column. All examinations were routinely performed on the day after operation, and thin endoscopes were selected for reducing the stress. Results: The internal pressure before endoscopy ranged from 6 to 20 cm H₂O, and during endoscopy ranged from 9 to 27 cm H₂O. The difference in the internal conduit pressure in each patient ranged from 1 to 9 cm H₂O. There was no increase in complications caused by endoscopy, including anastomotic leakage. Conclusion: This study is the first to report changes in internal pressure due to the endoscope by direct measurement. The pressure gradient observed was below the physiological pressure during swallowing. These results suggest that endoscopy is a safe examination even after surgery.

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Computed Tomography Versus Water-Soluble Contrast Swallow in the Detection of Intrathoracic Anastomotic Leak Complicating Esophagogastrectomy (Ivor Lewis)

Abstract: In comparison with CS only, CT at day 7 improves the sensitivity and negative predictive value for diagnosing an anastomotic leak. In case of doubt endoscopy is advisable. This approach provides an accurate assessment of the anastomosis before refeeding.

Cited by 76 publications

References 15 publications

Evaluation of Anastomotic Leak after Esophagectomy for Esophageal Cancer: Typical Time Point of Occurrence, Mode of Diagnosis, Value of Routine Radiocontrast Agent Studies and Therapeutic Options

Evaluation of Anastomotic Leak after Esophagectomy for Esophageal Cancer: Typical Time Point of Occurrence, Mode of Diagnosis, Value of Routine Radiocontrast Agent Studies and Therapeutic Options

Experiences in the management of anastomotic leakages and analysis of the factors affecting leakage healing in patients with esophagogastric junction cancer

Internal Pressure of the Conduit during Endoscopy on the Day after Esophagectomy

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