Thorac cardiovasc Surg
DOI: 10.1055/s-0037-1602829
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Early Postoperative Endoscopy for Evaluation of the Anastomosis after Esophageal Reconstruction

Tzu-Hsin Lin1, Pei-Ming Huang2
  • 1Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
  • 2Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Further Information

Publication History

01 November 2016

03 April 2017

Publication Date:
16 May 2017 (eFirst)

Abstract

Background Anastomotic leaks significantly affect hospital stay after esophageal surgery. Here, we investigated the efficacy of early endoscopy for predicting anastomotic healing and leaks after esophageal reconstruction.

Methods A total of 65 consecutive esophageal cancer patients treated by cervical esophagogastrostomy underwent routine endoscopy between postoperative days 5 and 7. The anastomosis was scored for the degree of ischemia, stenosis, and torsion of the anastomotic axis. Independent associations between ischemia, stenosis, and torsion of the proximal esophagus and the risk of the anastomotic leak were examined using Spearman's rank correlation method.

Results Assessment of the degree of mucosal ischemia in 65 patients shows well healing in 35, patch ischemia in 20, diffuse ischemia in 10, no necrosis in any patient. Stenosis was classified as 0 to 10% in 40 patients, 11 to 20% in 12, 21 to 80% in 11, and 81 to 100% in 2. The degree of torsion of the anastomotic axis was classified as 0 to 10 degrees in 52 patients, 11 to 90 degrees in 8, and 91 to 180 degrees in 5. With rising endoscopy scores, there was an increase in risk for leaks (score > 4.5, sensitivity 100%, and specificity 83.8%).

Conclusions Early postoperative endoscopy facilitates the management of esophagogastrostomy anastomosis to predict leaks.