Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy

Simon Roh; Mark D Iannettoni; John C Keech; Mohammad Bashir; Peter J Gruber; Kalpaj R Parekh

doi:10.5090/kjtcs.2016.49.2.99

Back

Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy

Journal article

Open access

Peer reviewed

Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy

Simon Roh, Mark D Iannettoni, John C Keech, Mohammad Bashir, Peter J Gruber and Kalpaj R Parekh

The Korean journal of thoracic and cardiovascular surgery, Vol.49(2), pp.99-106

04/2016

DOI: 10.5090/kjtcs.2016.49.2.99

PMCID: PMC4825910

PMID: 27066433

Files and links (1)

url

https://doi.org/10.5090/kjtcs.2016.49.2.99View

Published (Version of record) Open Access

Abstract

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. 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. 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. Barium swallow is an insensitive but specific test for detecting leaks at the cervical anastomotic site after esophagectomy.

Esophagectomy

Barium

Anastomotic leak

Esophagus

Details

Title: Subtitle: Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy
Creators: Simon Roh - Department of Radiology, University of Iowa Hospitals and Clinics
Mark D Iannettoni - Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University
John C Keech - Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics
Mohammad Bashir - Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics
Peter J Gruber - Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics
Kalpaj R Parekh - Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics
Resource Type: Journal article
Publication Details: The Korean journal of thoracic and cardiovascular surgery, Vol.49(2), pp.99-106
DOI: 10.5090/kjtcs.2016.49.2.99
PMID: 27066433
PMCID: PMC4825910
NLM abbreviation: Korean J Thorac Cardiovasc Surg
ISSN: 2233-601X
eISSN: 2093-6516
Publisher: Korea (South)
Grant note: K08 HL114725 / NHLBI NIH HHS
Language: English
Date published: 04/2016
Academic Unit: Anatomy and Cell Biology; Surgery; Cardiothoracic Surgery
Record Identifier: 9984025307602771

Metrics

56 Record Views