title: Radiologic versus endoscopic evaluation of the conduit after esophageal resection: a prospective, blinded, intraindividually controlled diagnostic study.
abstract: BACKGROUND
  Anastomotic leakage is a major complication in esophageal surgery. Although contrast swallow is performed by many surgical centers before reintroduction of oral intake to exclude anastomotic leakage postoperatively, endoscopy is increasingly used in this situation and may be superior. This study compares radiographic contrast study and endoscopy for the identification of local complications after subtotal esophagectomy.
  
  
  METHODS
  Between January 2006 and September 2007, a prospective, blinded, intraindividually controlled study was conducted in patients who underwent transthoracic esophagectomy due to esophageal cancer. A radiographic contrast study was performed prior to endoscopy on postoperative day 5-7. Technical feasibility, sensitivity, and specificity of the radiologic and endoscopic evaluations of the esophageal substitute were described.
  
  
  RESULTS
  Radiographic contrast study was possible in only 64% of the patients (35 of 55). The contrast study could not be performed in 20 patients due to contraindications or mechanical ventilation. Endoscopy could be performed in all patients (p < 0.001). Pathologic findings were detected in 13 patients by endoscopy but in only 1 patient by contrast swallow. Leakage of the anastomosis or the conduit was correctly detected in 7 patients by endoscopy but in only 1 patient by contrast swallow (p = 0.01). Endoscopy detected focal conduit necrosis or ischemia in six additional patients. Contrast studies showed false-positive results in two patients. Both sensitivity and specificity of endoscopy were 100%, while sensitivity and specificity of the contrast study were only 20 and 94%. No complications resulted from postoperative endoscopy or radiologic imaging.
  
  
  CONCLUSIONS
  Endoscopic evaluation of the esophageal substitute in the early postoperative course is possible in all patients without complications. Endoscopy is superior to the contrast study in detecting pathological findings after esophageal reconstruction. Radiologic contrast swallow in the early postoperative days is often not possible, has no further relevance, and should be replaced by endoscopic evaluation.
authors: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany, anja.schaible@med.uni-heidelberg.de.
authors: Anja
authors: A
authors: Schaible
authors: Peter
authors: P
authors: Sauer
authors: Werner
authors: W
authors: Hartwig
authors: Thilo
authors: T
authors: Hackert
authors: Ulf
authors: U
authors: Hinz
authors: Boris
authors: B
authors: Radeleff
authors: Markus W
authors: MW
authors: Büchler
authors: Jens
authors: J
authors: Werner
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000175:diagnosis; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D003287:Contrast Media; D004311:Double-Blind Method; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply; D006801:Humans; D007511:Ischemia / Q000175:diagnosis; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis*; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media