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Optimizing detection of postoperative leaks on upper gastrointestinal fluoroscopy: a step-by-step guide

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Abstract

Postoperative leaks after gastrointestinal surgery are important to identify to decrease patient morbidity and mortality. Fluoroscopic studies are commonly employed to detect postoperative leak. While the literature addresses the sensitivity and specificity of these examinations, there is generally a lack of description of the fluoroscopic technique itself and there may be variability between radiologists in how these studies are performed. It is important to balance a standardized fluoroscopy protocol while tailoring the exam for each surgical and patient situation. Here we will briefly review common postoperative anatomy in the upper gastrointestinal tract, propose fluoroscopic techniques to improve postoperative leak detection, and illustrate teaching points with clinical cases.

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Fig. 1

Adapted from Flanagan, et al. [9] and used with permission. a Cervical esophagus resection site (star) and gastric resection site (green line). b Anastomosis may be cervical or intrathoracic. Cervical anastomosis (straight arrow); gastric resection site (arrowhead); pyloromyotomy (curved arrow). Pyloromyotomy is sometimes performed at time of esophagectomy to prevent potential complication of gastric outlet obstruction

Fig. 2

Adapted from Levine et al. [10] and used with permission. Yellow arrow: small fundal pouch. Blue arrow: gastrojejunal anastomosis. Black arrow: Roux limb. Grey arrow: excluded stomach. White arrow: jejunojejunal anastomosis

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source of the leak

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Authors and Affiliations

  1. Department of Radiology, Northwestern University, Chicago, IL, USA

    Stephany L. Ross, Elizabeth V. Craig, Frank H. Miller, Jeanne M. Horowitz & Linda C. Kelahan

  2. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Balaji Veluswamy

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  1. Stephany L. Ross
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  2. Balaji Veluswamy
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Correspondence to Linda C. Kelahan.

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Ross, S.L., Veluswamy, B., Craig, E.V. et al. Optimizing detection of postoperative leaks on upper gastrointestinal fluoroscopy: a step-by-step guide. Abdom Radiol 46, 3019–3032 (2021). https://doi.org/10.1007/s00261-021-02978-0

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