title: Early postoperative endoscopy for targeted management of patients at risks of anastomotic complications after esophagectomy.
abstract: Early postoperative endoscopy after esophagectomy is assumed to be effective in detection and prediction of anastomotic complications, but overall effects of early postoperative endoscopy remain uncertain. The aim of this study was to investigate whether mucosal status assessed by early postoperative endoscopy could offer an approach to individualized management after esophagectomy.
  
  
  
  Endoscopy was performed in 176 of 214 patients who underwent esophagectomy at either 1 week or 2 weeks postoperatively. Mucosal damage in the proximal region of the graft was classified as follows: intact mucosa, mild mucosal degeneration, and severe mucosal degeneration. We examined the association of the severity of mucosal damage and the incidence of anastomotic complications.
  
  
  
  Twenty-eight patients (16%) developed anastomotic stricture. Symptomatic anastomotic leaks occurred in 15 patients (8.5%), including 6 with stricture. The frequency of intact mucosa, mild mucosal degeneration, and severe mucosal was 7%, 20%, and 73% for leaks; 4%, 11%, and 85% for strictures; and 28%, 62%, and 10% for no complications, respectively (P <.001). Asymptomatic leaks were found in 4 patients in the 1-week endoscopy group. Sensitivity and specificity for the development of stricture in 1-week/2-week were 0.88/0.83 and 0.85/0.98, respectively. Positive and negative predictive values were 0.52/0.91 and 0.97/0.96, respectively. Early postoperative endoscopy could be carried out without any adverse events in all patients.
  
  
  
  Assessment of the anastomosis and graft with early postoperative endoscopy was safe and resulted in a high predictive value for subsequent anastomotic complications. Early postoperative endoscopy may lead to targeted management for a subset of patients undergoing esophagectomy.
authors: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan. Electronic address: ka2nissy@gmail.com.
authors: Katsunori
authors: K
authors: Nishikawa
authors: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors: Tetsuji
authors: T
authors: Fujita
authors: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors: Masami
authors: M
authors: Yuda
authors: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors: SeRyung
authors: S
authors: Yamamoto
authors: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors: Yujiro
authors: Y
authors: Tanaka
authors: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors: Akira
authors: A
authors: Matsumoto
authors: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors: Yuichiro
authors: Y
authors: Tanishima
authors: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors: Fumiaki
authors: F
authors: Yano
authors: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors: Norio
authors: N
authors: Mitsumori
authors: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors: Katsuhiko
authors: K
authors: Yanaga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004940:Esophageal Stenosis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome