Endoscopy on post-operative day 4 after Ivor Lewis esophagectomy can help predict anastomotic outcome
Milica Bozovic, Oscar ÅkessonAbstract
Introduction
Anastomotic leakage (AL) is a serious complication after esophagectomy. Early prediction could enable detection and preventive measures to limit consequences of AL. The aim of this study was to evaluate endoscopy with systematic grading of the anastomosis on postoperative day 4 (POD 4) as a method to predict AL.
Methods
Seventyseven patients scheduled for Ivor Lewis esophagectomy were prospectively included and examined by endoscopy on POD 4. Hybrid esophagectomy was performed with a 25 or 28 mm circular stapling device to manufacture the anastomosis. The reconstruction was graded by the combined endoscopy score, 0 to 6, at three specific locations; circular anastomosis, longitudinal staple line and top of gastric tube. Outcome was recorded and graded based on the Esophageal Complications Consensus Group (ECCG) definition of AL.
Results
Out of 61 patients available for final analysis, 14,7% (n = 9) developed AL. Six out of 13 patients (46%) with a combined endoscopy score of ≥3, developed AL. Three out of 48 (6%) patients with a combined endoscopy score of ≤2, developed AL. The distribution of endoscopy scores was significantly different between the two groups AL versus no AL (Pearson P = 0.002).
Discussion
Endoscopy on POD 4 after Ivor Lewis esophagectomy seems safe and can be used to help predict anastomotic outcome. A combined endoscopy score of ≤2 on POD 4 predicts uneventful recovery as 45 out of 48 patients (94%) had normal anastomotic healing. A score of ≥3 may indicate need for close observation, altered nutrition management and postponed discharge.