An evaluation of the routine use of contrast radiography as a screening test for cervical anastomotic integrity after esophagectomy.

BACKGROUND

The use of contrast radiography as a screening test for anastomotic integrity after esophagectomy is unclear.

METHODS

Consecutive patients undergoing either transhiatal esophagectomy (THE) or pharyngolaryngoesophagectomy (PLE) with the cervical anastomosis performed by the same single surgeon were registered into a database. Anastomotic leak rate, modality of detection, and the result of esophagram (if performed) were recorded.

RESULTS

A total of 132 patients underwent esophagectomy (THE, 93 patients; PLE, 39 patients). Ninety-nine patients (75%) underwent contrast radiography. The overall leak rate was 12.1% (n = 16). Nine of 16 anastomotic leaks (56.3%) were detected without contrast radiography. Seven additional patients with anastomotic leaks underwent contrast radiography, 2 (28.6%) were true positives, 4 (57.1%) were false negatives, and 1 was equivocal (14.3%). Results of contrast esophagography modified patient management in only 2 instances, whereas 4 leaks were missed by this modality.

CONCLUSIONS

Most leaks (56.3%) were diagnosed without contrast esophagography. Contrast studies changed clinical management correctly in only 2 of 132 patients, while failing to diagnose 4 of 7 possible leaks. This study suggests that its routine use after THE or PLE is not indicated.