Clinical Application of Oral Meglumine Diatrizoate Esophagogram in Screening for Esophageal Fistula During Radiotherapy or Chemoradiotherapy for Esophageal Cancer

Abstract

Background: This study aimed to investigate the specificity and sensitivity of oral meglumine diatrizoate esophagogram in screening for esophageal fistula during radiotherapy or chemoradiotherapy for esophageal cancer and determine if early detection and intervention could improve the prognosis of esophageal fistulas. Methods: Esophageal cancer patients undergoing radiotherapy or chemoradiotherapy were included. Weekly oral meglumine diatrizoate esophagograms were performed to screen for esophageal fistulas during radiotherapy. When an esophageal fistula was detected, fibroesophagoscopy and computed tomography (CT) were used for confirmation; once confirmed, radiotherapy was discontinued, and the patient received intervention. The esophagogram results were reviewed weekly to assess the recovery of the esophageal fistula. If the fistula was healed, the patient resumed and completed radiotherapy. Results: A total of 206 patients with cancer of the esophagus undergoing chemotherapy/radiotherapy were included. During radiotherapy, 10 cases of esophageal fistula were detected or suspected based on the oral meglumine diatrizoate esophagography findings, and eight of those cases were confirmed by CT and esophagoscopy. All patients with esophageal fistula received intervention; among them, 62.5% (5/8) recovered after 1 to 2 weeks of treatment and continued radiotherapy to completion. The sensitivity and specificity of oral meglumine diatrizoate esophagography in screening for esophageal fistulas during radiotherapy or chemoradiotherapy were 100 and 98.9%, respectively. The median survival period of patients with esophageal fistulas was 6.4 months. Conclusion: Oral meglumine diatrizoate esophagography has high sensitivity and specificity in screening for esophageal fistulas during radiotherapy or chemoradiotherapy with minimal side effects. Early diagnosis and timely intervention can significantly improve the prognosis and prolong the survival period of patients. Trial Registration: Chictr.org.cn, Identifier: ChiCTR-DDD-17012617. Registered on September 7, 2017. The first participant was enrolled on September 25, 2017. http://www.chictr.org.cn/showproj.aspx?proj=21526 .

High incidence of esophageal fistula on patients with clinical T4b esophageal squamous cell carcinoma who received chemoradiotherapy: A retrospective analysis

“…Thirdly, half of the patients included in the study were staged as T4b by CT imaging and not by endoscopy. Furthermore, even though the esophagography and CT can be the alternative approaches to diagnose esophageal fistula formation, pre-treatment fistula could still not be fully excluded when endoscopy was not feasible in these patients with serious stenosis [28,29]. Despite these limitations, we consider that our study is the basis for developing clear selection criteria for the subgroup of T4b patients who would benefit from CRT and not develop fistula.…”

Quantitative CT analysis to predict esophageal fistula in patients with advanced esophageal cancer treated by chemotherapy or chemoradiotherapy

“…Most surgeons are concerned about barium extravasation into the thorax [22,23]. A recent study showed that oral meglumine diatrizoate esophagography using CT has a high sensitivity of 100% and a specificity of 98.9% in esophageal fistula screening [24]. However, in 20% of cases, the fistula could not be identified by preoperative CT.…”

Quantitative CT Analysis to Predict Esophageal Fistula in Patients With Advanced Esophageal Cancer Treated by Chemotherapy or Chemoradiotherapy

“…Most surgeons are concerned about barium extravasation into the thorax [21,22] . A recent study showed that oral meglumine diatrizoate esophagography using CT has a high sensitivity of 100% and a speci city of 98.9% in esophageal stula screening [23] .However, in 20% of cases, the stula could not be identi ed by preoperative CT. Indeed, water-soluble contrast agents are hyperosmolar and could draw uid into the lungs, causing pulmonary edema in case of aspiration into the tracheobronchial tree [21] .…”