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Am J Surg. 2012 Apr;203(4):467-71. doi: 10.1016/j.amjsurg.2011.04.005. Epub 2011 Sep 9.

An evaluation of the routine use of contrast radiography as a screening test for cervical anastomotic integrity after esophagectomy.

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  • 1Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA.

Abstract

BACKGROUND:

The use of contrast radiography as a screening test for anastomotic integrity after esophagectomy is unclear.

METHODS:

Consecutive patients undergoing either transhiatal esophagectomy (THE) or pharyngolaryngoesophagectomy (PLE) with the cervical anastomosis performed by the same single surgeon were registered into a database. Anastomotic leak rate, modality of detection, and the result of esophagram (if performed) were recorded.

RESULTS:

A total of 132 patients underwent esophagectomy (THE, 93 patients; PLE, 39 patients). Ninety-nine patients (75%) underwent contrast radiography. The overall leak rate was 12.1% (n = 16). Nine of 16 anastomotic leaks (56.3%) were detected without contrast radiography. Seven additional patients with anastomotic leaks underwent contrast radiography, 2 (28.6%) were true positives, 4 (57.1%) were false negatives, and 1 was equivocal (14.3%). Results of contrast esophagography modified patient management in only 2 instances, whereas 4 leaks were missed by this modality.

CONCLUSIONS:

Most leaks (56.3%) were diagnosed without contrast esophagography. Contrast studies changed clinical management correctly in only 2 of 132 patients, while failing to diagnose 4 of 7 possible leaks. This study suggests that its routine use after THE or PLE is not indicated.

Copyright © 2012 Elsevier Inc. All rights reserved.

PMID:
21906717
[PubMed - indexed for MEDLINE]
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