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

Abstract

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.