title: Should routine assessment of anastomotic integrity be undertaken using radiological contrast swallow after oesophagectomy with intra-thoracic anastomosis? Best evidence topic (BET).
abstract: Thoracic anastomotic leak is associated with significant postoperative morbidity and mortality. Routine contrast oesophagograms are consequently employed by a number of centres to routinely screen for this complication yet there exists little consensus as to if and when this assessment should occur. We have demonstrated within this BestBET analysis of five level IV case series that routine contrast oesophagograms lack adequate sensitivity or positive predictive value to be effective as screening tools, with leaks often arising clinically prior to scheduled routine assessment. We additionally demonstrate the significant risk of aspiration associated with contrast swallow use. The use of contrast swallow studies as diagnostic tools in patients for whom a leak is considered likely on the basis of clinical examination is nevertheless supported by relatively greater negative predictive values and specificity reported within the literature. There is additional evidence to support the use of CT imaging with oral contrast and endoscopic assessment of the anastomosis as valuable tools to assess for anastomotic integrity.
authors.affiliation: College of Medical & Dental Sciences, University of Birmingham, United Kingdom.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Jones
authors.affiliation: University Department of Surgery, Royal Adelaide Hospital, North Terrace Adelaide, South Australia, SA 5000, Australia.
authors.forename: Brigette
authors.initials: B
authors.lastname: Clarke
authors.affiliation: University of Adelaide, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Heah
authors.affiliation: Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, United Kingdom. Electronic address: ewen.griffiths@uhb.nhs.uk.
authors.forename: Ewen A
authors.initials: EA
authors.lastname: Griffiths
mesh_terms: D057868:Anastomotic Leak / Q000000981:diagnostic imaging* / Q000209:etiology; D003287:Contrast Media; D016629:Esophagectomy / Q000379:methods; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D011859:Radiography; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media
keywords: Anastomotic leak; Contrast examination; Imaging; Oesophageal surgery; Oesophagectomy; Thoracic