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Published: 2017-03-28

Routine Use of Contrast Swallow After Total Gastrectomy and Esophagectomy: Is it Justified?

Nader El-Sourani, Helge Bruns, Achim Troja, Hans-Rudolf Raab, Dalibor Antolovic

(European Medical School, University Hospital for General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany)

Pol J Radiol 2017; 82:170-173

DOI: 10.12659/PJR.899951

BACKGROUND: After gastrectomy or esophagectomy, esophagogastrostomy and esophagojejunostomy are commonly used for reconstruction. Water-soluble contrast swallow is often used as a routine screening to exclude anastomotic leakage during the first postoperative week. In this retrospective study, the sensitivity and specificity of oral water-soluble contrast swallow for the detection of anastomotic leakage and its clinical symptoms were analysed.
MATERIAL AND METHODS: Records of 104 consecutive total gastrectomies and distal esophagectomies were analysed. In all cases, upper gastrointestinal contrast swallow with the use of a water-soluble contrast agent was performed on the 5th postoperative day. Extravasation of the contrast agent was defined as anastomotic leakage. When anastomotic insufficiency was suspected but no extravasation was present, a computed tomography (CT) scan and upper endoscopy were performed.
RESULTS: Oral contrast swallow detected 7 anastomotic leaks. Based on CT-scans and upper endoscopy, the true number of anastomotic leakage was 15. The findings of the oral contrast swallow were falsely positive in 4 and falsely negative in 12 patients, respectively. The sensitivity and specificity of the oral contrast swallow was 20% and 96%, respectively.
CONCLUSIONS: Routine radiological contrast swallow following total gastrectomy or distal esophagectomy cannot be recommended. When symptoms of anastomotic leakage are present, a CT-scan and endoscopy are currently the methods of choice.

Keywords: Contrast Media, Esophagectomy, Gastrectomy, multidetector computed tomography, Swallows

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