Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy
Background: Barium swallow is performed following esophagectomy to evaluate the anastomosis for detection of leaks and to assess the emptying of the gastric conduit. The aim of this study was to evaluate the reliability of the barium swallow study in diagnosing anastomotic leaks following esophage...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Korean Society for Thoracic and Cardiovascular Surgery
2016-04-01
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| Series: | Korean Journal of Thoracic and Cardiovascular Surgery |
| Subjects: | |
| Online Access: | http://www.kjtcvs.org/journal/download_pdf.php?doi=10.5090/kjtcs.2016.49.2.99 |
| _version_ | 1818537542876659712 |
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| author | Simon Roh Mark D. Iannettoni John C. Keech Mohammad Bashir Peter J. Gruber Kalpaj R. Parekh |
| author_facet | Simon Roh Mark D. Iannettoni John C. Keech Mohammad Bashir Peter J. Gruber Kalpaj R. Parekh |
| author_sort | Simon Roh |
| collection | DOAJ |
| description | Background: Barium swallow is performed following esophagectomy to evaluate the anastomosis for detection of
leaks and to assess the emptying of the gastric conduit. The aim of this study was to evaluate the reliability of
the barium swallow study in diagnosing anastomotic leaks following esophagectomy. Methods: Patients who underwent
esophagectomy from January 2000 to December 2013 at our institution were investigated. Barium swallow
was routinely done between days 5–7 to detect a leak. These results were compared to clinically determined leaks
(defined by neck wound infection requiring jejunal feeds and or parenteral nutrition) during the postoperative period.
The sensitivity and specificity of barium swallow in diagnosing clinically significant anastomotic leaks was
determined. Results: A total of 395 esophagectomies were performed (mean age, 62.2 years). The indications for
the esophagectomy were as follows: malignancy (n=320), high-grade dysplasia (n=14), perforation (n=27), benign
stricture (n=7), achalasia (n=16), and other (n=11). A variety of techniques were used including transhiatal (n=351),
McKeown (n=35), and Ivor Lewis (n=9) esophagectomies. Operative mortality was 2.8% (n=11). Three hundred and
sixty-eight patients (93%) underwent barium swallow study after esophagectomy. Clinically significant anastomotic
leak was identified in 36 patients (9.8%). Barium swallow was able to detect only 13/36 clinically significant leaks.
The sensitivity of the swallow in diagnosing a leak was 36% and specificity was 97%. The positive and negative
predictive values of barium swallow study in detecting leaks were 59% and 93%, respectively. Conclusion: Barium
swallow is an insensitive but specific test for detecting leaks at the cervical anastomotic site after esophagectomy. |
| first_indexed | 2024-12-11T18:52:06Z |
| format | Article |
| id | doaj.art-24f240a3a8364046b685a36707dce8d9 |
| institution | Directory Open Access Journal |
| issn | 2233-601X 2093-6516 |
| language | English |
| last_indexed | 2024-12-11T18:52:06Z |
| publishDate | 2016-04-01 |
| publisher | Korean Society for Thoracic and Cardiovascular Surgery |
| record_format | Article |
| series | Korean Journal of Thoracic and Cardiovascular Surgery |
| spelling | doaj.art-24f240a3a8364046b685a36707dce8d92022-12-22T00:54:16ZengKorean Society for Thoracic and Cardiovascular SurgeryKorean Journal of Thoracic and Cardiovascular Surgery2233-601X2093-65162016-04-014929910610.5090/kjtcs.2016.49.2.99Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following EsophagectomySimon Roh0Mark D. Iannettoni1John C. Keech2Mohammad Bashir3Peter J. Gruber4Kalpaj R. Parekh5University of Iowa Hospitals and ClinicsEast Carolina UniversityUniversity of Iowa Hospitals and ClinicsUniversity of Iowa Hospitals and ClinicsUniversity of Iowa Hospitals and ClinicsUniversity of Iowa Hospitals and ClinicsBackground: Barium swallow is performed following esophagectomy to evaluate the anastomosis for detection of leaks and to assess the emptying of the gastric conduit. The aim of this study was to evaluate the reliability of the barium swallow study in diagnosing anastomotic leaks following esophagectomy. Methods: Patients who underwent esophagectomy from January 2000 to December 2013 at our institution were investigated. Barium swallow was routinely done between days 5–7 to detect a leak. These results were compared to clinically determined leaks (defined by neck wound infection requiring jejunal feeds and or parenteral nutrition) during the postoperative period. The sensitivity and specificity of barium swallow in diagnosing clinically significant anastomotic leaks was determined. Results: A total of 395 esophagectomies were performed (mean age, 62.2 years). The indications for the esophagectomy were as follows: malignancy (n=320), high-grade dysplasia (n=14), perforation (n=27), benign stricture (n=7), achalasia (n=16), and other (n=11). A variety of techniques were used including transhiatal (n=351), McKeown (n=35), and Ivor Lewis (n=9) esophagectomies. Operative mortality was 2.8% (n=11). Three hundred and sixty-eight patients (93%) underwent barium swallow study after esophagectomy. Clinically significant anastomotic leak was identified in 36 patients (9.8%). Barium swallow was able to detect only 13/36 clinically significant leaks. The sensitivity of the swallow in diagnosing a leak was 36% and specificity was 97%. The positive and negative predictive values of barium swallow study in detecting leaks were 59% and 93%, respectively. Conclusion: Barium swallow is an insensitive but specific test for detecting leaks at the cervical anastomotic site after esophagectomy.http://www.kjtcvs.org/journal/download_pdf.php?doi=10.5090/kjtcs.2016.49.2.99EsophagectomyAnastomotic leakBariumEsophagus |
| spellingShingle | Simon Roh Mark D. Iannettoni John C. Keech Mohammad Bashir Peter J. Gruber Kalpaj R. Parekh Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy Korean Journal of Thoracic and Cardiovascular Surgery Esophagectomy Anastomotic leak Barium Esophagus |
| title | Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy |
| title_full | Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy |
| title_fullStr | Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy |
| title_full_unstemmed | Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy |
| title_short | Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy |
| title_sort | role of barium swallow in diagnosing clinically significant anastomotic leak following esophagectomy |
| topic | Esophagectomy Anastomotic leak Barium Esophagus |
| url | http://www.kjtcvs.org/journal/download_pdf.php?doi=10.5090/kjtcs.2016.49.2.99 |
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