Effectiveness of screening aqueous contrast swallow in detecting clinically significant anastomotic leaks after esophagectomy

Eur Surg Res. Mar-Apr 2005;37(2):123-8. doi: 10.1159/000084544.

Abstract

Background: Aqueous contrast swallow study is recommended as a screening procedure for the evaluation of esophageal anastomotic integrity following esophagectomy. The aim of this study was to assess the accuracy of water-soluble contrast swallow screening as a predictor of clinically significant anastomotic leak in patients with esophagectomy.

Patients and methods: The records of 505 consecutive patients undergoing esophagectomy in Mayo Clinic from January 1991 through December 1995 were retrospectively reviewed. 464 (92%) patients had water-soluble contrast swallows performed in the early postoperative period (median postoperative day 7, range 4-11 days).

Results: A total of 39 radiological leaks were obtained but only 17 of these had clinical signs of anastomotic leakage. Furthermore, 25 patients who had normal swallow study developed a clinical anastomotic leak. There were therefore 22 (4.7%) false positive and 25 (5.4%) false negative results giving values for the specificity, sensitivity and false negative error rate of the radiological examination of 94.7, 40.4, and 59.5% respectively. Aspiration of the contrast agent was noted on fluoroscopy in 30 (6.5%) patients. Only 2 (0.4%) patients developed aqueous contrast agent-caused aspiration pneumonia. There was no procedure-related mortality.

Conclusion: While radiological assessment of esophageal anastomoses in the early postoperative period using aqueous contrast agents appears to be a relatively safe procedure, the poor sensitivity and high false negative error rate of this technique, when performed on postoperative day 7 and in a series with clinical anastomotic leak rate of 9%, is insufficient for it to be worthwhile as a screening procedure.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Surgical
  • Child
  • Child, Preschool
  • Contrast Media / administration & dosage*
  • Diatrizoate Meglumine / administration & dosage*
  • Esophagectomy*
  • False Negative Reactions
  • False Positive Reactions
  • Female
  • Humans
  • Male
  • Mass Screening / methods*
  • Middle Aged
  • Postoperative Complications / diagnostic imaging*
  • Radiography
  • Retrospective Studies

Substances

  • Contrast Media
  • Diatrizoate Meglumine