Detection of esophageal perforation using intraesophageal dye injection.
OBJECTIVE
Esophageal perforation complicating anterior cervical spine surgery is a potentially fatal complication. Early identification and immediate treatment may lower adverse effects for the patient. The purpose of this study is to assess the efficacy of intraesophageal dye injection to detect an esophageal injury and to test two novel techniques.


METHODS
Ten cadaveric specimens were dissected using an anteromedial Smith-Robinson approach. Each was sequentially tested by a control and three dye injection techniques: technique A: nasogastric tube alone; technique B: nasogastric tube plus a distally placed Foley catheter; technique C: proximal plus a distally placed Foley catheter. Each technique was tested against esophageal perforations created by needle puncture (21-gauge, 18-gauge, and 14-gauge) and by a 2-mm high-speed burr. Dye visualization was independently graded as present or absent by two authors.


RESULTS
In the control trial, no dye leak was visualized in any of the 10 specimens. In technique A, 0 of 10 21-gauge perforations, 1 of 10 18-gauge perforations, 2 of 10 14-gauge perforations, and 6 of 10 burr perforations were visualized. In technique B, 1 of 10 21-gauge perforations, 8 of 10 18-gauge perforations, 9 of 10 14-gauge perforations, and 9 of 10 burr perforations were visualized. In technique C, 0 of 10 21-gauge perforations, 9 of 10 18-gauge perforations, 10 of 10 14-gauge perforations, and 7 of 10 burr perforations were visualized.


CONCLUSIONS
The study suggests that intraesophageal dye injection via nasogastric tube alone should not be relied upon to exclude the presence of esophageal perforation. Two novel techniques showed an improved, though limited, capability of detecting esophageal perforations.
Taylor
Brett
B
Department of Orthopedic Surgery, Barnes-Jewish Hospital at Washington University School of Medicine, Saint Louis, MO, USA.
Patel
Alpesh A
AA
Okubadejo
Gbolahan O
GO
Albert
Todd
T
Riew
K Daniel
KD
D002102:Cadaver; D004396:Coloring Agents / Q000008:administration & dosage; D004939:Esophageal Perforation / Q000175:diagnosis*; D006801:Humans; D066298:In Vitro Techniques; D007203:Indigo Carmine / Q000008:administration & dosage*; D007267:Injections / Q000379:methods; D014950:Wounds, Penetrating / Q000175:diagnosis*
D004396:Coloring Agents; D007203:Indigo Carmine