Prospective study of routine contrast radiology after total gastrectomy.
BACKGROUND
The practice of routine contrast radiology before recommencing oral nutrition after total gastrectomy is not evidence based. The aim of this prospective study was to evaluate the clinical role and timing of this investigation.


METHODS
Seventy-six consecutive patients underwent total gastrectomy with a stapled oesophagojejunal anastomosis. A contrast swallow using non-ionic contrast and barium was performed routinely 5 and 9 days after surgery. The surgeon was blinded to the result of the first of these examinations. Patients with clinical evidence of a leak underwent contrast radiology and upper gastrointestinal videoendoscopy.


RESULTS
Eight patients (11 per cent) developed a clinical leak from the oesophagojejunal anastomosis, seven before the first scheduled contrast swallow. Contrast radiology identified a leak in four of six patients. Endoscopy detected a leak in both patients with a false-negative swallow and in two patients who were not fit to undergo contrast radiology. Routine contrast radiology identified a subclinical leak in a further five patients (7 per cent), none of whom developed clinical signs. Four of seven in-hospital deaths were associated with an anastomotic leak.


CONCLUSIONS
There is no role for routine contrast swallow after total gastrectomy with a stapled oesophagojejunal anastomosis, but patients with clinical suspicion of leakage should undergo urgent contrast radiology, plus endoscopy if the contrast examination is normal.
Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK.
P J
PJ
Lamb
S M
SM
Griffin
M V
MV
Chandrashekar
D L
DL
Richardson
D
D
Karat
N
N
Hayes
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001466:Barium Sulfate; D003287:Contrast Media; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D013272:Stomach Diseases / Q000401:mortality / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome
D003287:Contrast Media; D001466:Barium Sulfate