Simon Roh MD, Presenter: Nothing to Disclose

Mark Iannettoni MD, Abstract Co-Author: Nothing to Disclose

John Keech MD, Abstract Co-Author: Nothing to Disclose

Peter Gruber MD, PhD, Abstract Co-Author: Nothing to Disclose

Kalpaj Parekh MBBS, Abstract Co-Author: Nothing to Disclose

The standard of practice following esophagectomy is to evaluate the anastomosis by a barium swallow for detection of leaks. The aim of this study was to evaluate the reliability of the barium swallow study compared to clinical evaluation in diagnosing anastomotic leaks following esophagectomy.

We studied all consecutive patients with either transhiatal or transthoracic esophagectomy between January 2000 and December 2013 at our institution. Patients were evaluated for anastomotic leak by routine barium swallow study on post-op day 5. These results were compared to clinically determined leaks (defined by neck wound infection requiring jejunal feeds and or parenteral nutrition) during the postoperative period. The sensitivity and specificity of barium swallow in diagnosing clinically significant anastomotic leaks was determined.

A total of 382 esophagectomies were performed [mean age 62.1 (21-88) years], [malignancy (n=313), high grade dysplasia (n=15), benign stricture/perforation (n=35), and other (n=19)]. A variety of techniques were used including transhiatal (n=341), McKeown (n=34), and Ivor Lewis (n=7) esophagectomies. Operative mortality was 2.9% (n=11). 356 patients (93%) underwent barium swallow study after esophagectomy [mean postoperative day 6.4 (3-75)]. Clinically significant anastomotic leak was identified in 32 (9.0%) patients [malignancy 84% (n=27), high grade dysplasia 13% (n=4), benign stricture/perforation 3% (n=1)]. The sensitivity of the swallow in diagnosing a leak was 35% and specificity was 98%. The positive and negative predictive values of barium swallow study in detecting leaks were 58% and 94%, respectively.

Barium swallow is an insensitive but specific test for detecting leaks at the cervical anastomotic site after esophagectomy.

Our practice has evolved to resume oral intake two weeks after the surgery even in the case barium swallow is negative for a leak.

Roh, S, Iannettoni, M, Keech, J, Gruber, P, Parekh, K, Barium Swallow Is Insensitive in Diagnosing Clinically Significant Anastomotic Leaks Following Esophagectomy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045592.html