Routine or on demand radiological contrast examination in the diagnosis of anastomotic leakage after esophagectomy

Honing, Judith; Pultrum, Bareld B.; Jagt, Eric J. van der; Groen, Henk; Plukker, John

doi:10.1002/jso.21401

Cited by 17 publications

(10 citation statements)

References 17 publications

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“…The earliest patient to be diagnosed by endoscopy suffered an AL 5 days after the operation. A total of 6 patients were diagnosed by performing a contrast study after clinical suspicion of AL, as recommended by Honing et al [22]. Four patients were diagnosed using methylene blue, indicating that this technique nowadays has only a limited significance but can be applied in selected cases such as in patients with early suspicious secretion from the peri-anastomotic drainage.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…11 However, more recent studies seem to suggest that swallows should only be performed on clinical concern because of the low sensitivity of this method for detecting leaks. [11][12][13] The evidence to support the use of routine contrast swallows is lacking and some studies have shown that swallows should only be requested in cases where an anastomotic leak is suspected clinically.…”

Section: Other Literaturementioning

confidence: 99%

Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages

Tang

Humes

Gemmil

et al. 2013

annals

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INTRODUCTIONThe high mortality and morbidity associated with resection for oesophagogastric malignancy has resulted in a conservative approach to the postoperative management of this patient group. In August 2009 we introduced an enhanced recovery after surgery (ERAS) pathway tailored to patients undergoing resection for oesophagogastric malignancy. We aimed to assess the impact of this change in practice on standard clinical outcomes. METHODS Two cohorts were studied of patients undergoing resection for oesophagogastric malignancy before (August 2008 -July 2009) and after (August 2009 -July 2010) the implementation of the ERAS pathway. Data were collected on demographics, interventions, length of stay, morbidity and in-hospital mortality. RESULTS There were 53 and 55 oesophagogastric resections undertaken respectively for malignant disease in each of the study periods. The median length of stay for both gastric and oesophageal resection decreased from 15 to 11 days (MannWhitney U, p<0.001) following implementation of the ERAS pathway. There was no significant increase in morbidity (gastric resection 23.1% vs 5.3% and oesophageal resection 25.9% vs 16.7%) or mortality (gastric resection no deaths and oesophageal resection 1.8% vs 3.6%) associated with the changes. There was a significant decrease in the number of oral contrast studies used following oesophageal resection, with a reduction from 21 (77

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“…These complications should be detected and managed immediately because the complications can be fatal if the detection is delayed. However, most anastomotic sites are inside the body; therefore, evaluation of anastomosis has to be performed by indirect methods, physical findings, blood test, X-ray, computed tomography, or contrast swallow [6,7]. …”

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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Routine or on demand radiological contrast examination in the diagnosis of anastomotic leakage after esophagectomy

Cited by 17 publications

References 17 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

Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages

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

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