title: Routine Use of Contrast Swallow After Total Gastrectomy and Esophagectomy: Is it Justified?
abstract: BACKGROUND
  After gastrectomy or esophagectomy, esophagogastrostomy and esophagojejunostomy are commonly used for reconstruction. Water-soluble contrast swallow is often used as a routine screening to exclude anastomotic leakage during the first postoperative week. In this retrospective study, the sensitivity and specificity of oral water-soluble contrast swallow for the detection of anastomotic leakage and its clinical symptoms were analysed.
  
  
  METHODS
  Records of 104 consecutive total gastrectomies and distal esophagectomies were analysed. In all cases, upper gastrointestinal contrast swallow with the use of a water-soluble contrast agent was performed on the 5thpostoperative day. Extravasation of the contrast agent was defined as anastomotic leakage. When anastomotic insufficiency was suspected but no extravasation was present, a computed tomography (CT) scan and upper endoscopy were performed.
  
  
  RESULTS
  Oral contrast swallow detected 7 anastomotic leaks. Based on CT-scans and upper endoscopy, the true number of anastomotic leakage was 15. The findings of the oral contrast swallow were falsely positive in 4 and falsely negative in 12 patients, respectively. The sensitivity and specificity of the oral contrast swallow was 20% and 96%, respectively.
  
  
  CONCLUSIONS
  Routine radiological contrast swallow following total gastrectomy or distal esophagectomy cannot be recommended. When symptoms of anastomotic leakage are present, a CT-scan and endoscopy are currently the methods of choice.
authors.affiliation: European Medical School, University Hospital for General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany.
authors.forename: Nader
authors.initials: N
authors.lastname: El-Sourani
authors.affiliation: European Medical School, University Hospital for General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Bruns
authors.affiliation: European Medical School, University Hospital for General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: Troja
authors.affiliation: European Medical School, University Hospital for General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany.
authors.forename: Hans-Rudolf
authors.initials: HR
authors.lastname: Raab
authors.affiliation: European Medical School, University Hospital for General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany.
authors.forename: Dalibor
authors.initials: D
authors.lastname: Antolovic
keywords: Contrast Media; Esophagectomy; Gastrectomy; Multidetector Computed Tomography; Swallows