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Routine Contrast Esophagram has Minimal Impact on the Postoperative Management of Patients Undergoing Esophagectomy for Esophageal Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Routine contrast esophagram is frequently performed after esophagectomy in order to detect occult anastomotic leak (AL). This modality has a low sensitivity, and its routine use has been called into question. Accordingly, we sought to demonstrate the clinical impact of routine contrast esophagography in the management of patients undergoing esophagectomy for malignant disease.

Methods

All patients undergoing esophagectomy from 2005 to 2011 for malignancy at a North American University hospital were identified from a prospectively collected database. Barium esophagram (BE) was performed within the first week postoperatively. Patients were dichotomized according to whether they had an AL, and the sensitivity and specificity of BE was determined. The clinical impact of the BE result, defined as cessation of enteral feeding, additional interventions, or delay in discharge, was determined.

Results

Overall, 221 patients underwent esophagectomy. Thirty (13.6 %) developed an AL, of which 10 (30 %) had a positive BE, 12 (40 %) had a negative BE, and 8 (26.7 %) had no BE and were diagnosed clinically (1/8), by computed tomography (CT) (3/8), endoscopically (3/8), or at reoperation (1/7). AL in patients with a negative BE was confirmed clinically (4/12), by CT (6/12), endoscopically (1/12), or at reoperation (1/12). The sensitivity and specificity of BE was 45.5 and 97.8 %, respectively. BE altered postoperative management in 8/221 (3.6 %) patients, with 5/221 (2.3 %) undergoing therapeutic intervention. Conversely, 3/221 (1.4 %) patients demonstrated clinically insignificant AL, delaying discharge and feeding without intervention.

Conclusion

Contrast esophagram is not an effective screening modality for AL when employed routinely following esophagectomy.

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Authors and Affiliations

  1. Department of Surgery, McGill University Health Center, Montreal General Hospital, McGill University, Montreal, QC, Canada

    Jonathan Cools-Lartigue MD, Amin Andalib MD, Ali Abo-Alsaud MD, Stephen Gowing MD, Maxime Nguyen MD, David Mulder MD & Lorenzo Ferri MD, PhD

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  1. Jonathan Cools-Lartigue MD
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  2. Amin Andalib MD
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  3. Ali Abo-Alsaud MD
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  4. Stephen Gowing MD
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  5. Maxime Nguyen MD
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  6. David Mulder MD
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  7. Lorenzo Ferri MD, PhD
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Corresponding author

Correspondence to Lorenzo Ferri MD, PhD.

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Cools-Lartigue, J., Andalib, A., Abo-Alsaud, A. et al. Routine Contrast Esophagram has Minimal Impact on the Postoperative Management of Patients Undergoing Esophagectomy for Esophageal Cancer. Ann Surg Oncol 21, 2573–2579 (2014). https://doi.org/10.1245/s10434-014-3654-1

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  • DOI: https://doi.org/10.1245/s10434-014-3654-1

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