title: Role of endoscopy to predict a leak after esophagectomy.
abstract: OBJECTIVE
  After esophageal surgery, many centers conduct a routine diagnostic test before reintroducing oral intake. However, the clinical value in asymptomatic patients has been questioned. Therefore, we left this decision to the discretion of the operating surgeon and documented the data prospectively.
  
  
  METHODS
  Between 2007 and 2013, 185 consecutive patients underwent elective esophageal resection in our institution. The decision as to whether an endoscopy was to be performed as a routine-check or when a leak was clinically suspected was at the discretion of the operating surgeon. An immediate endoscopy was performed on emerging clinical signs of a leak. If a routine check was planned, it was performed between postoperative days 5-7.
  
  
  RESULTS
  Of the 185 patients, 84 % had an endoscopy of the anastomosis during the hospital stay. Of the patients who underwent an endoscopy, 61 % were on a routine-check. In this group, one patient showed a leak at the time of endoscopy, 11 patients had pathological findings, 3 of these patients developed a leak later. Eighty-three patients had no pathological findings; nevertheless, 7 developed a leak later. In the on-demand-group, 10 patients showed a leak at the time of endoscopy.
  
  
  CONCLUSIONS
  In a minority of patients, a routine-check of the anastomosis between days 5-7 revealed pathological findings that later led to an anastomotic leak (3/11). In contrast, a routine-check without pathological findings could not rule out the development of a future leak (7/83). Therefore, we conclude that routine postoperative studies to identify leaks after esophageal resection are not justified.
authors.affiliation: Department of General Surgery, University of Heidelberg, INF 110, 69120, Heidelberg, Germany. Anja.Schaible@med.uni-heidelberg.de.
authors.forename: Anja
authors.identifier: http://orcid.org/0000-0001-9271-4139
authors.initials: A
authors.lastname: Schaible
authors.affiliation: Department of General Surgery, University of Heidelberg, INF 110, 69120, Heidelberg, Germany.
authors.forename: Alexis
authors.initials: A
authors.lastname: Ulrich
authors.affiliation: Department of General Surgery, University of Heidelberg, INF 110, 69120, Heidelberg, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.affiliation: Department of General Surgery, University of Heidelberg, INF 110, 69120, Heidelberg, Germany.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.affiliation: Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Sauer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000209:etiology*; D000066491:Clinical Decision-Making; D004724:Endoscopy; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies
keywords: Endoscopy; Esophagectomy; Routine diagnostics