NESS - 2010 Annual Meeting Abstracts: An Evaluation of the Routine Use of Contrast Esophagography as a Screening Test for Cervical Anastomotic Integrity Following Esophagectomy

2010 Annual Meeting Abstracts

An Evaluation of the Routine Use of Contrast Esophagography as a Screening Test for Cervical Anastomotic Integrity Following Esophagectomy
*Daniel G Solomon, Ronald R Salem
Yale University School of Medicine, New Haven, CT

An Evaluation of the Routine Use of Contrast Esophagography as a Screening Test for Cervical Anastomotic Integrity Following Esophagectomy
OBJECTIVE: To evaluate the prognostic quality of contrast esophagography as a screening test for anastomotic integrity following esophagectomy.
DESIGN: Retrospective analysis
SETTING: University hospital inpatient surgical service
PATIENTS: One hundred and one consecutive patients undergoing either transhiatal esophagectomy (THE) or pharyngo-laryngo-esophagectomy (PLE) with the cervical anstomosis performed by the same single surgeon.
INTERVENTION: N/A
MAIN OUTCOME MEASURED: Gastro-esophageal anastomotic leak rate, modality of detection and the result of the corresponding esophagram (if performed) were recorded. Pre and post-operative bio-physical parameters were also recorded.
RESULTS: 101 patients underwent esophagectomy with cervical anastomosis between February 1998 and June 2009 (THE: 70, PLE 31). 76 patients (75.3%) underwent contrast esophagram to evaluate anastimotic integrity. The overall leak rate was 12.9% (n=13). 11 of 13 anastomotic leaks (84.6%) were detected prior to esophagram. 4 additional patients with anastomotic leaks underwent contrast esophagography, 2 (50%) of these esophagrams were true positives, while 2 (50%) were false negatives. Results of contrast esophagography modified patient management in only 2 instances, while 2 leaks were missed by this modality. Post-operative fever, leukocytosis/leucopenia, hypo/hyperglycemia, and incisional erythema or drainage were all significantly associated with the subsequent diagnosis of anastomotic leaks (p<0.05).
CONCLUSIONS: The majority of leaks (84.6%) were diagnosed prior to contrast esophagography. Contrast esophagram changed clinical management in only 2 of 101 patients. This study suggests that its routine use after THE or PLE should be questioned.

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