Effectiveness of screening aqueous contrast swallow in detecting clinically significant anastomotic leaks after esophagectomy

M. B. Tirnaksiz, C. Deschamps, M. S. Allen, C. Daniel Johnson, P. C. Pairolero

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Background: Aqueous contrast swallow study is recommended as a screening procedure for the evaluation of esophageal anastomotic integrity following esophagectomy. The aim of this study was to assess the accuracy of water-soluble contrast swallow screening as a predictor of clinically significant anastomotic leak in patients with esophagectomy. Patients and Methods: The records of 505 consecutive patients undergoing esophagectomy in Mayo Clinic from January 1991 through December 1995 were retrospectively reviewed. 464 (92%) patients had water-soluble contrast swallows performed in the early postoperative period (median postoperative day 7, range 4-11 days). Results: A total of 39 radiological leaks were obtained but only 17 of these had clinical signs of anastomotic leakage. Furthermore, 25 patients who had normal swallow study developed a clinical anastomotic leak. There were therefore 22 (4.7%) false positive and 25 (5.4%) false negative results giving values for the specificity, sensitivity and false negative error rate of the radiological examination of 94.7, 40.4, and 59.5% respectively. Aspiration of the contrast agent was noted on fluoroscopy in 30 (6.5%) patients. Only 2 (0.4%) patients developed aqueous contrast agent-caused aspiration pneumonia. There was no procedure-related mortality. Conclusion: While radiological assessment of esophageal anastomoses in the early postoperative period using aqueous contrast agents appears to be a relatively safe procedure, the poor sensitivity and high false negative error rate of this technique, when performed on postoperative day 7 and in a series with clinical anastomotic leak rate of 9%, is insufficient for it to be worthwhile as a screening procedure.

Original languageEnglish (US)
Pages (from-to)123-128
Number of pages6
JournalEuropean Surgical Research
Volume37
Issue number2
DOIs
StatePublished - Mar 1 2005

Fingerprint

Anastomotic Leak
Esophagectomy
Deglutition
Contrast Media
Postoperative Period
Swallows
Aspiration Pneumonia
Water
Fluoroscopy
Sensitivity and Specificity
Mortality

Keywords

  • Anastomotic leak
  • Esophagectomy
  • Gastrografin
  • Water-soluble contrast agent

ASJC Scopus subject areas

  • Surgery

Cite this

Effectiveness of screening aqueous contrast swallow in detecting clinically significant anastomotic leaks after esophagectomy. / Tirnaksiz, M. B.; Deschamps, C.; Allen, M. S.; Johnson, C. Daniel; Pairolero, P. C.

In: European Surgical Research, Vol. 37, No. 2, 01.03.2005, p. 123-128.

Research output: Contribution to journalArticle

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abstract = "Background: Aqueous contrast swallow study is recommended as a screening procedure for the evaluation of esophageal anastomotic integrity following esophagectomy. The aim of this study was to assess the accuracy of water-soluble contrast swallow screening as a predictor of clinically significant anastomotic leak in patients with esophagectomy. Patients and Methods: The records of 505 consecutive patients undergoing esophagectomy in Mayo Clinic from January 1991 through December 1995 were retrospectively reviewed. 464 (92{\%}) patients had water-soluble contrast swallows performed in the early postoperative period (median postoperative day 7, range 4-11 days). Results: A total of 39 radiological leaks were obtained but only 17 of these had clinical signs of anastomotic leakage. Furthermore, 25 patients who had normal swallow study developed a clinical anastomotic leak. There were therefore 22 (4.7{\%}) false positive and 25 (5.4{\%}) false negative results giving values for the specificity, sensitivity and false negative error rate of the radiological examination of 94.7, 40.4, and 59.5{\%} respectively. Aspiration of the contrast agent was noted on fluoroscopy in 30 (6.5{\%}) patients. Only 2 (0.4{\%}) patients developed aqueous contrast agent-caused aspiration pneumonia. There was no procedure-related mortality. Conclusion: While radiological assessment of esophageal anastomoses in the early postoperative period using aqueous contrast agents appears to be a relatively safe procedure, the poor sensitivity and high false negative error rate of this technique, when performed on postoperative day 7 and in a series with clinical anastomotic leak rate of 9{\%}, is insufficient for it to be worthwhile as a screening procedure.",
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AB - Background: Aqueous contrast swallow study is recommended as a screening procedure for the evaluation of esophageal anastomotic integrity following esophagectomy. The aim of this study was to assess the accuracy of water-soluble contrast swallow screening as a predictor of clinically significant anastomotic leak in patients with esophagectomy. Patients and Methods: The records of 505 consecutive patients undergoing esophagectomy in Mayo Clinic from January 1991 through December 1995 were retrospectively reviewed. 464 (92%) patients had water-soluble contrast swallows performed in the early postoperative period (median postoperative day 7, range 4-11 days). Results: A total of 39 radiological leaks were obtained but only 17 of these had clinical signs of anastomotic leakage. Furthermore, 25 patients who had normal swallow study developed a clinical anastomotic leak. There were therefore 22 (4.7%) false positive and 25 (5.4%) false negative results giving values for the specificity, sensitivity and false negative error rate of the radiological examination of 94.7, 40.4, and 59.5% respectively. Aspiration of the contrast agent was noted on fluoroscopy in 30 (6.5%) patients. Only 2 (0.4%) patients developed aqueous contrast agent-caused aspiration pneumonia. There was no procedure-related mortality. Conclusion: While radiological assessment of esophageal anastomoses in the early postoperative period using aqueous contrast agents appears to be a relatively safe procedure, the poor sensitivity and high false negative error rate of this technique, when performed on postoperative day 7 and in a series with clinical anastomotic leak rate of 9%, is insufficient for it to be worthwhile as a screening procedure.

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