Drain fluid amylase as a sensitive biomarker for the early detection of anastomotic leakage in ileal pouch surgery

Abstract

Aim We studied the levels of amylase in drain fluid to investigate its utility as a biomarker of anastomotic leak in ileal pouch patients who did not have a covering loop ileostomy. The luminal contents of the small intestine are high in amylase. Ileal J pouches are formed for restoration of continuity in patients with ulcerative colitis after removal of the colon and rectum. A drain is placed alongside the ileal pouch in the pelvis. Method This study is a retrospective analysis of prospectively collected daily drain fluid amylase levels in consecutive patients undergoing restorative proctectomy and ileal J pouch anal anastomosis, without a covering loop ileostomy, between November 2016 and April 2018. Results Thirteen patients underwent surgery without a covering loop ileostomy. Two patients suffered an anastomotic leak and were returned to theatre, one on day 5 and the other on day 6 postoperatively. The mean daily drain fluid amylase level in those who did not leak was between 25 and 46 U/l with a range of 22–139 U/l for all samples collected. In the two patients who suffered a clinical leak the drain fluid amylase level rose to 22 432 and 10 212 U/l on the day of clinical leak diagnosis. The mean rectal tube (intraluminal) amylase level was 63 097 U/l as measured on day 1 postoperatively. Conclusion In this small cohort of patients, the measurement of drain fluid amylase is a highly sensitive biomarker of clinical anastomotic leak.

Geographical Variation in the Use of Diverting Loop Ileostomy in Australia and New Zealand Colorectal Surgeons

“…A local biomarker in the setting of IPAA is amylase, which can be measured simply and quantitatively in drain fluid. It has already been shown, in an early study from this institution, that amylase is present in high concentrations in enteric content from the rectal tube [ 25 ]. There is ongoing research to assess its utility in early diagnosis of AL.…”

Amylase quantification in the terminal Ileum following formation of an Ileostomy

“…This knowledge could be applied to the sampling and analysis of abdominal wound or drain fluid to indicate a communication with the gut. In preliminary studies, the detection of amylase in pelvic drain fluid has been evaluated as a potential biomarker of anastomotic leak in ileal pouch surgery 10 . Sampling amylase in abdominal wound fluid may similarly be utilized to detect if there is evidence of a direct communication with the ileal lumen and may be an adjunct to the diagnosis of an enterocutaneous fistula.…”

Gastrografin can be detected in ex vivo biological specimens by dual‐energy CT scanning

“…In studies measuring extravasated intraluminal substances in drain fluid after low pelvic colorectal anastomoses, it has been shown that these substances are significantly elevated in the setting of anastomotic leak. 9 This protocol could offer a simple, quick, reliable and reproducible method for identifying the presence of Gastrografin in drain fluid in patients suffering an anastomotic leak and with high intraluminal concentrations of administered enteral Gastrografin. Indeed, regular DECT testing of ex vivo drain fluid may serve as a helpful biomarker and avoids any exposure of the patient to ionising radiation.…”