Radiological detection of post-oesophagectomy anastomotic leak — a comparison between multidetector CT and fluoroscopy

Abstract

The purpose of this study was to directly compare CT with fluoroscopy for the diagnosis of occult anastomotic leak following oesophagectomy. Patients undergoing oesophagectomy and gastric conduit formation for the treatment of oesophageal cancer were eligible for inclusion. Imaging was performed 6-8 days post-operatively. Patients underwent multislice CT examination of the chest and abdomen with a bolus of oral contrast, followed by fluoroscopic water-soluble contrast swallow (with subsequent use of barium if this was normal). The studies were reviewed by a consultant radiologist, who was blinded to the results of the other modality. Images were reported as showing "no leak", "possible leak" or "definite leak". The presence of mediastinal gas or fluid or extraluminal contrast at CT was recorded. The clinical outcome after reinstituition of oral intake was used as a reference standard. Patient preference for modality was recorded. 52 patients were recruited. Four were found to have leak on CT and fluoroscopy. 11 had possible leak at CT, but normal fluoroscopy: 2 of these had a leak confirmed later, whereas 9 had no leak. 37 had normal CT and fluoroscopy findings, and remained clinically well. The sensitivity, specificity, positive and negative predictive values were 100%, 80%, 40% and 100%, respectively, for CT, and 67%, 100%, 100% and 96%, respectively, for fluoroscopy. The positive predictive value of mediastinal air, air/fluid and extraluminal contrast were 25%, 75% and 50%, respectively. 35 patients found CT more tolerable. In conclusion, CT was better tolerated and more sensitive but less specific than fluoroscopy for detecting occult anastomotic leak.

Routine or on demand radiological contrast examination in the diagnosis of anastomotic leakage after esophagectomy

“…Regarding the superiority of these exams no consensus has been reached. The study of Hogan et al [14] showed a Journal of Surgical Oncology higher specificity for CT compared to water-soluble contrast examination, but in the study of Upponi et al [15] the specificity was lower while the sensitivity was higher for CT. However, CT is preferred by patients and is more suitable in less mobile patients [14,15].…”

“…The study of Hogan et al [14] showed a Journal of Surgical Oncology higher specificity for CT compared to water-soluble contrast examination, but in the study of Upponi et al [15] the specificity was lower while the sensitivity was higher for CT. However, CT is preferred by patients and is more suitable in less mobile patients [14,15]. Other investigators recommend the use of both contrast swallow and endoscopy to confirm a leak in case of clinical suspicion [16].…”

Esofagograma: imágenes que valen mas que mil palabras

“…Esofagograma en proyecciones oblicua lateral (izquierda) y anteroposterior (derecha) en las que se identifica crecimiento auricular izquierdo (línea curva) que impronta y desplaza el esófago hacia la izquierda con nivel hidroaéreo (flecha punteada) por tránsito lento. cificidad en presencia de fugas de la anastomosis se acerca al 100% (30,31) (Figura 11).…”

“…Este estudio, además, provee información adicional sobre la presencia de aspiración y del adecuado vaciamiento del conducto usado para su reconstrucción (estómago o colon) (30,31) (Figuras 1 y 11).…”

“…La detección temprana de sus complicaciones permite una rápida actuación por parte del cirujano para prevenir mayores complicaciones (30,31). El esofagograma es un estudio de gran utilidad para evaluar el éxito de un procedimiento quirúr-gico, así como los problemas que se pueden derivar a partir de este; las estenosis de las anastomosis y las fugas anastomóticas son un claro ejemplo.…”