Early Postoperative Endoscopy for Evaluation of the Anastomosis after Esophageal Reconstruction

Abstract

Early postoperative endoscopy facilitates the management of esophagogastrostomy anastomosis to predict leaks.

Early detection of complications: anastomotic leakage

“…Most surgeons are reluctant to conduct endoscopy because of the theoretical risk of injury to the anastomosis or worsening AL (18). However, endoscopy performed within one week, even on the first operative day, after esophagectomy is safe and feasible because intraluminal pressure greater than 80 cmH 2 O is known to be required to disrupt the anastomosis, while the intraluminal maximum insufflation at the anastomosis never exceeds 9 cmH 2 O and rarely disturbs blood flow in the conduit (21,31,38,(44)(45)(46). In addition, the procedure can be conducted at bedside, even in a patient who is on ventilation without worsening an already existing AL (12,45).…”

“…Endoscopy after esophagectomy may be necessary in cases in which the results of CT-scan are not confirmatory (16,17). In summary, endoscopy offers the advantages of possible repetitive examinations, early diagnosis, guiding further treatments, shortening natural healing time, and reducing complications (21,31,44). Recently, fluorescence endoscopy using matrix metalloproteinase, which plays a crucial role in regulation of wound healing, have been reported as a promising tool for early identification of AL in a murine model (47).…”

Implicación de las células madre derivadas del tejido adiposo en la cicatrización de heridas de pacientes obesos y pacientes oncológicos

“…To explore the viability of ASCs to benefit wound healing, the previous studies by our group has analyzed the characteristics of ASCs derived from either obese or cancer patients whose risk of poor healing discouraged use of these cells as therapeutic tools [19][20][21][22] . Obesity, defined as abnormal or excessive accumulation of fat, is associated with low-grade chronic inflammation of adipose tissue 19 , possibly impairing health 20 .…”

“…Obesity, defined as abnormal or excessive accumulation of fat, is associated with low-grade chronic inflammation of adipose tissue 19 , possibly impairing health 20 . In cancer patients, tumors activate molecular and cellular mechanisms linked to impaired wound healing 21,22 . This impairment is also affected by the systemic toxic effect of the chemotherapy drugs and radiation therapies these patients frequently receive 23,24 .…”

Comparison of a modified one‑piece mechanical and double‑layer hand‑sewn anastomosis in McKeown esophagogastrectomy: A single‑institute retrospective study

“…Once it occurs, patients suffered decreased quality of life, protracted hospitalization or even death. This is why there were many innovations and modifications in reconstructive surgery including functional end-to-end stapling, triangulating stapling, T-shaped linear stapling, pre-embedded stapling, and so forth (11)(12)(13)(14)(15).…”