Skip to main content

Advertisement

SpringerLink
Log in

Role of endoscopy to predict a leak after esophagectomy

  • ORIGINAL ARTICLE
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

After esophageal surgery, many centers conduct a routine diagnostic test before reintroducing oral intake. However, the clinical value in asymptomatic patients has been questioned. Therefore, we left this decision to the discretion of the operating surgeon and documented the data prospectively.

Methods

Between 2007 and 2013, 185 consecutive patients underwent elective esophageal resection in our institution. The decision as to whether an endoscopy was to be performed as a routine-check or when a leak was clinically suspected was at the discretion of the operating surgeon. An immediate endoscopy was performed on emerging clinical signs of a leak. If a routine check was planned, it was performed between postoperative days 5–7.

Results

Of the 185 patients, 84 % had an endoscopy of the anastomosis during the hospital stay. Of the patients who underwent an endoscopy, 61 % were on a routine-check. In this group, one patient showed a leak at the time of endoscopy, 11 patients had pathological findings, 3 of these patients developed a leak later. Eighty-three patients had no pathological findings; nevertheless, 7 developed a leak later. In the on-demand-group, 10 patients showed a leak at the time of endoscopy.

Conclusions

In a minority of patients, a routine-check of the anastomosis between days 5–7 revealed pathological findings that later led to an anastomotic leak (3/11). In contrast, a routine-check without pathological findings could not rule out the development of a future leak (7/83). Therefore, we conclude that routine postoperative studies to identify leaks after esophageal resection are not justified.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Lam T, Fok M, Cheng S, Wong J (1992) Anastomotic complications after oesophagectomy for cancer - a comparison of neck and chest anastomoses. J Thorac Cardiovasc Surg 104:395–400

    CAS  PubMed  Google Scholar 

  2. Sauvenet A, Baltar J, Le Mee J (1998) J. B. Diagnosis and conservative management of intrathoracic leakage after oesophagectomy. Br J Surg 85:1446–1449

    Article  Google Scholar 

  3. Karl R, Schreiber R, Boulvare D, et al. (2000) Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy. Ann Surg 231:635–643

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Alanezi K, Urschel J (2004) Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg 10:71–75

    PubMed  Google Scholar 

  5. Griffin S, Lamb P, Dresner S, et al. (2001) Diagnosis and management of a mediastinal leak following radical oesophagectomy. Br J Surg 88:1346–1351

    Article  CAS  PubMed  Google Scholar 

  6. Siewert J, Stein H, Bartels H (2004) Anastomotic insufficiencies in the upper gastrointestinal tract. Chirurg 75:1063–1070

    Article  CAS  PubMed  Google Scholar 

  7. Dewar L, Gelfand G, Finley R, et al. (1992) Factors affecting anastomotic leak and stricture formation following esophagectomy and gastric tube interposition. Am J Surg 163:484–489

    Article  CAS  PubMed  Google Scholar 

  8. Rizk N, Bach P, Schrag D, et al. (2004) The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J Am Coll Surg 198:42–50

    Article  PubMed  Google Scholar 

  9. Lagarde S, De Boer J, Kate F, et al. (2008) Postoperative complications after esophagectomy for adenocarcinoma of the esophagus are related to timing of death due to recurrence. Ann Surg 247:71–76

    Article  PubMed  Google Scholar 

  10. Bardini R, Bonavina L, Asolati M, et al. (1994) Single-layered cervical esophageal anastomoses: a prospective study of two suturing techniques. Ann Thorac Surg 58:1087–1090

    Article  CAS  PubMed  Google Scholar 

  11. Lerut T (2000) The surgeon as a prognostic factor. Ann Surg 232:729–732

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Whooley B, Law S, Murthy S, et al. (2001) Analysis of reduced death and complication rates after esophageal resection. Ann Surg 3:338–344

    Article  Google Scholar 

  13. Birkmeyer J, Stukel T, Siewers A, et al. (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349:2117–2127

    Article  CAS  PubMed  Google Scholar 

  14. Briel J, Tamhankar A, Hagen J, et al. (2004) Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis. J Am Coll Surg 198:536–541

    Article  PubMed  Google Scholar 

  15. Bruce J, Krukowski Z, Al-Kjairy G, et al. (2001) Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 88:1157–1168

    Article  CAS  PubMed  Google Scholar 

  16. Palmes D, Brüwer M, Bader FG, et al. (2011) Diagnostic evaluation, surgical technique, and perioperative management after esophagectomy: consensus statement of the German advanced surgical treatment study group. Langenbeck's Arch Surg 396:857–866

    Article  Google Scholar 

  17. Nambirajan L, Rintala R, Losty P, et al. (1998) The value of early postoperative oesophagography following repair of oesophageal atresia. Pediatr Surg Int 13:76–78

    Article  CAS  PubMed  Google Scholar 

  18. Fernandez-Fernandez L, Tejero E, Tieso A (1996) Randomized trial of fibrin glue to seal mechanical oesophagojejunal anastomosis. Br J Surg 83:42–46

    Article  Google Scholar 

  19. Runkel L, Walz M, Ketelhut M (2015) Abdominothoracic eaophageal resection according to Ivor Lewis with intrathoracic anastomosis. Chirurg 86:468–475

    Article  CAS  PubMed  Google Scholar 

  20. Page R, Shackcloth M, Russell G, Pennefather S (2005) Surgical treatment of anastomotic leaks after oesophagectomy. Eur J Cardiothorac Surg 27:337–343

    Article  PubMed  Google Scholar 

  21. Manegold B (1981) Early postoperative endoscopy in the operated stomach. Endoscopy 13:104–107

    Article  CAS  PubMed  Google Scholar 

  22. Hölscher A, Vallböhmer D, Brabender J (2006) The prevention and management of perioperative complications. Best Pract Res Clin Gastroenterol 20:907–923

    Article  PubMed  Google Scholar 

  23. Maish M, DeMeesters S, Choustoulakis E, et al. The safety and usefulness of endoscopy for evaluation of the graft and anastomosis early after esophagectomy and reconstruction. Surg Endosc 2005 19:1093–1102

  24. Schaible A, Sauer P, Hartwig W, et al. (2014) Radiologic versus endoscopic evaluation of the conduit after esophageal resection: a prospective, blinded, intraindividually controlled diagnostic study. Surg Endosc 28:2078–2085

    Article  PubMed  Google Scholar 

  25. Fan S, Lau W, Yip W, et al. (1988) Limitations and dangers of gastrografin swallow after esophageal and upper gastric operations. Am J Surg 155(3):495–497

    Article  CAS  PubMed  Google Scholar 

  26. Obertop H, Bosscha K, De Graaf P (1994) Mediastinitis from anastomotic disruption after esophageal resection and reconstruction for cancer: results of salvage surgery. Dis Esophagus 7:184–187

    Google Scholar 

  27. Liebermann-Meffert D, Meier R, Siewert J (1992) Vascular anatomy of the gastric tube used for esophageal reconstruction. Ann Thorac Surg 54:1110–1115

    Article  CAS  PubMed  Google Scholar 

  28. Schilling M, Mettler D, Redaelli C, Büchler M (1997) Circulatory and anatomic differences among experimental gastric tubes as esophageal replacement. World J Surg 21:992–997

    Article  CAS  PubMed  Google Scholar 

  29. Lerut T, Coosemans W, De Leyn P, et al. (2001) Optimizing treatment of carcinoma of the esophageus and gastroesophageal junction. Surg Oncol Clin North Am 10:863–884

    CAS  Google Scholar 

  30. Akiyama H, Miyazono H, Tsurumaru M, et al. (1978) Use of the stomach as an esophageal substitute. Ann Surg 188:606–610

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Buchler M, Baer H, Seiler C, Schilling M (1996) A technique for gastroplasty as a substitute for the esophagus: fundus rotation gastroplasty. J Am Coll Surg 182:241–245

    CAS  PubMed  Google Scholar 

  32. Urschel J (1995) Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg 169:634–640

    Article  CAS  PubMed  Google Scholar 

  33. Crestanello J, Deschamps C, Cassivi S, et al. (2005) Selective management of intrathoracic anastomotic leak after esophagectomy. J Thorac Cardiovasc Surg 129:254–260

    Article  PubMed  Google Scholar 

  34. Oezcelik A, Banki F, Ayazi S, et al. (2010) Detection of gastric conduit ischemia or anastomotic breakdown after cervical esophagogastrostomy: the use of computed tomography scan versus early endoscopy. Surg Endosc 24:1948–1951

    Article  PubMed  Google Scholar 

  35. Amr MA, Alzghari MJ, Polites SF, et al. (2014) Endoscopy in the early postoperative setting after primary gastrointestinal anastomosis. J Gastrotintest Surg 18:1911–1916

    Article  Google Scholar 

  36. Blencowe NS, Strong S, Angus GK, et al. (2012) Reporting of short-term clinical outcomes after esophagectomy. Ann Surg 255:658–666

    Article  PubMed  Google Scholar 

  37. Hogan BA, Winter D, Broe P, et al. (2008) Prospective trial comparing contrast swallow, computed tomography and endoscopy to identify anastomotic leak following oesophagogastric surgery. Surg Endosc 22:767–771

    Article  PubMed  Google Scholar 

  38. Hartung W, Strobel O, Lordick F, Büchler MW, Werner J (2008) Multimodal therapy of esophageal cancer. Z Gastroenterol 46:1207–1213

    Article  PubMed  Google Scholar 

  39. Urschel JD, Vasan H, Blewett CJ (2002) A meta-analysis of randomized controlled trials that compared neoaduvant chemotherapy and surgery to surgery alone for resectable esophageal cancer. Am J Surg 183:274–279

    Article  PubMed  Google Scholar 

  40. Kumagai K, Rouvelas I, Tsai JA, Mariosa D, Klevebro F, Lindblad M, Ye W, Lundell L, Nilsson M (2014) Meta-analysis of postoperative morbidity and perioperative mortality in patients receiving neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal and gastro-oesophageal junctional cancers. BJS 101:321–338

    Article  CAS  Google Scholar 

  41. Valverde A, Hay J, Fingerhut A, et al. (1996) Manual versus mechanical esophagogastric anastomosis after resection for carcinoma: a controlled trial. Surgery 120:476–483

    Article  CAS  PubMed  Google Scholar 

  42. Turkyilmaz A, Eroglu A, Aydin Y, Tekinbas C, Muharrem E, Karaoglanoglu N (2009) The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus 22:119–126

    Article  CAS  PubMed  Google Scholar 

  43. Cerfolio RJ, Bryant AS, Bass CS, Alexander JR, Bartolucci A (2004) Fast tracking after Ivor Lewis esophagogastrectomy. Chest 126:1187–1196

    Article  PubMed  Google Scholar 

  44. Ghaferi A, Birkmeyer JD, Dimick JB (2009) Complications, failure to rescue, and mortality with major inpatient surgery in Medicare patients. Ann Surg 250:1029–1034

    Article  PubMed  Google Scholar 

  45. Lorentz T, Fok M, Wong J (1989) Anastomotic leakage after resection and bypass for esophageal cancer: lessons learned from the past. World J Surg 13:472–477

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, University of Heidelberg, INF 110, 69120, Heidelberg, Germany

    Anja Schaible, Alexis Ulrich, Ulf Hinz & Markus W. Büchler

  2. Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany

    Peter Sauer

Authors
  1. Anja Schaible
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexis Ulrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ulf Hinz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Markus W. Büchler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter Sauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anja Schaible.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schaible, A., Ulrich, A., Hinz, U. et al. Role of endoscopy to predict a leak after esophagectomy. Langenbecks Arch Surg 401, 805–812 (2016). https://doi.org/10.1007/s00423-016-1486-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-016-1486-0

Keywords

Search

Navigation