The use of grape juice in the detection of esophageal leaks

Abstract

Background: Esophagectomies and repair of esophageal perforations are operations used for a variety of clinical indications. Anastomotic leaks are a major post-operative complication after these procedures. At our institution, we routinely use grape juice to detect esophageal leaks in the post-operative setting in addition to other standard imaging modalities. We hypothesize that grape juice can provide similar diagnostic sensitivity and specificity to other modalities for leak detection.

Methods: A retrospective review of all patients who underwent an esophagectomy or repair of esophageal perforations from 2013-2019 by the thoracic surgery service at our institution was performed. All patients underwent a barium swallow study, CT imaging or upper endoscopy, as well as ingesting purple grape juice on post-operative day 5 or greater. Purple grape juice observed in the tube thoracostomy drainage system was identified as a positive esophageal leak.

Results: Sixty-four patients were included in the study period (25% female, 88% white, median age 62 years old). Sixty-three patients had both a barium swallow study and grape juice test, while one patient underwent CT imaging and grape juice study. Grape juice test sensitivity and specificity were found to be 80% and 98.3%, respectively.

Conclusions: This pilot study demonstrates the effectiveness of using grape juice in detecting esophageal leaks after esophageal operations in patients with tube thoracostomies. Grape juice may be cheaper and potentially less morbid than other studies performed to detect esophageal leaks. Further research is needed to justify the increased use of grape juice in patients who undergo esophageal operations.

Keywords: Esophagectomy; barium swallow; esophageal leak; grape juice.

Figure 1

Inclusion and exclusion criteria for data collection. This represents the 64 patients who were included, broken down by imaging modalities, and then further by number of patients with leaks. Patients with leaks were further excluded for sensitivity and specificity analysis.

Figure 2

Algorithm for detection and management of esophageal anastomotic leak. This represents the current clinical utility of the grape juice swallow study at our institution and the clinical decision making pathway depending on test results and patient presentation. EGD, esophagogastroduodenoscopy.