title: Routine or on demand radiological contrast examination in the diagnosis of anastomotic leakage after esophagectomy.
abstract: BACKGROUND
  To detect anastomotic leakage after esophagectomy in esophageal carcinoma patients, many surgeons perform a radiological contrast examination routinely. The aim of this retrospective study is to determine the clinical relevance of a routine contrast examination after esophagectomy and to evaluate criteria for contrast examination on demand.
  
  
  METHODS
  Data were obtained from 211 patients with cancer of the esophagus or gastro-esophageal junction who underwent an esophagectomy during the period 1991-2004. Retrospectively, we analyzed patients regarding anastomosis-related characteristics and clinical signs including sepsis, fever > or = 39.0 degrees C, leukocytosis > or = 20 x 10(9)/ml and pleural effusion.
  
  
  RESULTS
  Anastomotic leakage had appeared in 35 of the 211 patients. The clinical signs sepsis (odds ratio (OR) 6.72: 95% confidence interval (CI) (2.57-17.56); P < 0.0001), leukocytosis (OR 2.62 (1.10-6.22); P < 0.030), and fever (OR 2.34 (1.01-5.42); P < 0.047) were significantly related to anastomotic leakage. Pleural effusion was not significantly related to anastomotic leakage (OR 2.83 (0.98-8.13); P = 0.054).
  
  
  CONCLUSIONS
  Our study suggests that the clinical value for a routinely performed contrast examination is debatable. We recommend performing a contrast examination based on clinical suspicion and clinical signs of anastomotic leakage including sepsis, fever > or = 39.0 degrees C and leukocytosis > or = 20 x 10(9)/ml.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: Honing
authors.forename: Bareld B
authors.initials: BB
authors.lastname: Pultrum
authors.forename: Eric J
authors.initials: EJ
authors.lastname: van der Jagt
authors.forename: Henk
authors.initials: H
authors.lastname: Groen
authors.forename: John Th M
authors.initials: JT
authors.lastname: Plukker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D003287:Contrast Media; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media