title: Routine contrast esophagram has minimal impact on the postoperative management of patients undergoing esophagectomy for esophageal cancer.
abstract: BACKGROUND
  Routine contrast esophagram is frequently performed after esophagectomy in order to detect occult anastomotic leak (AL). This modality has a low sensitivity, and its routine use has been called into question. Accordingly, we sought to demonstrate the clinical impact of routine contrast esophagography in the management of patients undergoing esophagectomy for malignant disease.
  
  
  METHODS
  All patients undergoing esophagectomy from 2005 to 2011 for malignancy at a North American University hospital were identified from a prospectively collected database. Barium esophagram (BE) was performed within the first week postoperatively. Patients were dichotomized according to whether they had an AL, and the sensitivity and specificity of BE was determined. The clinical impact of the BE result, defined as cessation of enteral feeding, additional interventions, or delay in discharge, was determined.
  
  
  RESULTS
  Overall, 221 patients underwent esophagectomy. Thirty (13.6 %) developed an AL, of which 10 (30 %) had a positive BE, 12 (40 %) had a negative BE, and 8 (26.7 %) had no BE and were diagnosed clinically (1/8), by computed tomography (CT) (3/8), endoscopically (3/8), or at reoperation (1/7). AL in patients with a negative BE was confirmed clinically (4/12), by CT (6/12), endoscopically (1/12), or at reoperation (1/12). The sensitivity and specificity of BE was 45.5 and 97.8 %, respectively. BE altered postoperative management in 8/221 (3.6 %) patients, with 5/221 (2.3 %) undergoing therapeutic intervention. Conversely, 3/221 (1.4 %) patients demonstrated clinically insignificant AL, delaying discharge and feeding without intervention.
  
  
  CONCLUSIONS
  Contrast esophagram is not an effective screening modality for AL when employed routinely following esophagectomy.
authors.affiliation: Department of Surgery, McGill University Health Center, Montreal General Hospital, McGill University, Montreal, QC, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cools-Lartigue
authors.forename: Amin
authors.initials: A
authors.lastname: Andalib
authors.forename: Ali
authors.initials: A
authors.lastname: Abo-Alsaud
authors.forename: Stephen
authors.initials: S
authors.lastname: Gowing
authors.forename: Maxime
authors.initials: M
authors.lastname: Nguyen
authors.forename: David
authors.initials: D
authors.lastname: Mulder
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ferri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003955:Diagnostic Tests, Routine; D019468:Disease Management; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D016629:Esophagectomy; D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011184:Postoperative Period; D011379:Prognosis; D012372:ROC Curve; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media