title: Endoscopy after esophagectomy: Safety demonstrated in a porcine model.
abstract: Endoscopy is useful in assessing conduit ischemia and anastomotic leaks after esophagectomy but poses a theoretical threat of anastomotic disruption. We used a porcine model to evaluate the safety of endoscopy after esophagectomy.
  
  
  
  We performed esophagectomies in 10 live pigs and performed endoscopy with progressive air insufflation and continuous intraluminal pressure monitoring. We stopped insufflation when the intraluminal pressure reached a plateau. We assessed the integrity of the conduit and anastomosis via endoscopy. We also performed pulse oximetry of the stomach and Doppler velocimetry of the right gastroepiploic artery on 5 live pigs to study the effects of endoscopic gastric insufflation.
  
  
  
  With gentle air insufflation, there was no measurable increase in intraluminal pressure, disruption of the conduit or anastomosis, or significant gastric distension. With progressive insufflation, the intraluminal pressure reached a plateau at a maximum of 8.7 ± 2.1 cm H2O (95% confidence interval, 7.2-10.2). At this plateau, air leaked retrograde via the mouth, which prevented further gastric distension. There were no significant changes in oxyhemoglobin saturation along various regions in the stomach even with maximal insufflation sustained for 10 minutes. There was a momentary reduction in gastroepiploic flow from 12.0 ± 1.0 [95% confidence interval, 10.8-13.2] mL/min/100 g to 9.6 ± 1.5 [95% confidence interval, 7.8-11.4] mL/min/100 g immediately after maximal insufflation, but flow recovered to 11 ± 1.3 [9.6, 12.8] mL/min/100 g after 10 minutes of sustained insufflation.
  
  
  
  Endoscopy after esophagectomy with gentle or maximal air insufflation results in safe endoluminal pressures and minimal disturbance of blood flow and oxygenation.
authors.affiliation: Department of General Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Vignesh
authors.initials: V
authors.lastname: Raman
authors.affiliation: Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Moodie
authors.affiliation: Department of General Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Obinna O
authors.initials: OO
authors.lastname: Ofoche
authors.affiliation: President and CEO, Temple University Health System, Philadelphia, Pa; Department of Thoracic Medicine and Surgery, Temple University Health System, Philadelphia, Pa.
authors.forename: Larry R
authors.initials: LR
authors.lastname: Kaiser
authors.affiliation: Department of Thoracic Medicine and Surgery, Temple University Health System, Philadelphia, Pa. Electronic address: cherie.p.erkmen@tuhs.temple.edu.
authors.forename: Cherie P
authors.initials: CP
authors.lastname: Erkmen
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D004724:Endoscopy; D016629:Esophagectomy; D004947:Esophagus / Q000601:surgery*; D008670:Metals; D015607:Stents; D013270:Stomach / Q000601:surgery; D013552:Swine
chemical_list: D008670:Metals
keywords: anastomosis; endoscopy; esophagectomy; insufflation; ischemia; leak; pressure