Prospective trial comparing contrast swallow,computed tomography and endoscopy to identify anastomotic leak following oesophagogastric surgery |
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Authors: | Brian A Hogan Desmond Winter David Broe Patrick Broe Michael J Lee |
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Institution: | (1) Department of Radiology, R.C.S.I. Educational & Research Centre, Beaumont Hospital, Dublin 9, Ireland;(2) Department of Surgery, Beaumont Hospital, Dublin, Ireland;(3) Present address: 31, 1535 Trossacks Avenue, N5F 4R1 London, Ontario, Canada |
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Abstract: | Background Anastomotic leaks are a major complication of oesophagogastric surgery. We compare contrast swallow fluoroscopy, computed
tomography (CT) with oral contrast and endoscopy in identifying anastomotic leaks following oesophagogastric surgery.
Methods A prospective trial of 38 patients undergoing oesophagogastric resection was undertaken with informed consent and institutional
review board (ethics committee) approval. Patients underwent all three investigations (over 24 hours) 1 week postoperatively.
Results Eight (21%) had clinically apparent leaks. Three pseudo-leaks were suggested on contrast swallow but were confirmed normal
on CT and endoscopy. Contrast swallow and CT missed one anastomotic leak each. Endoscopy identified anastomotic defects in
three patients, in whom CT and contrast swallow were either normal or conflicting.
Conclusions Routine tests of anastomotic integrity are unnecessary. When clinically suspected, contrast swallow or CT with oral contrast
will identify most leaks. Endoscopy is useful in cases where there are incongruous results. |
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Keywords: | Anastomotic leak Oesophagectomy Gastrectomy Endoscopy |
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