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Clinical Trial
. 2023 Jan 17;408(1):37.
doi: 10.1007/s00423-023-02783-x.

Endoscopic mucosal ischemic index for predicting anastomotic complications after esophagectomy: a prospective cohort study

Shinichiro Kobayashi  1 , Kengo Kanetaka  2 , Akira Yoneda  3 , Naoyuki Yamaguchi  4 , Kazuma Kobayashi  5 , Yasuhiro Nagata  5   6 , Yasuhiro Maruya  2 , Shun Yamaguchi  5 , Masaaki Hidaka  5 , Susumu Eguchi  5
Affiliations
Clinical Trial

Endoscopic mucosal ischemic index for predicting anastomotic complications after esophagectomy: a prospective cohort study

Shinichiro Kobayashi et al. Langenbecks Arch Surg. .

Erratum in

Abstract

Background: Postoperative complications related to gastric conduit reconstruction are still common issues after McKeown esophagectomy. A novel endoscopic mucosal ischemic index is desired to predict anastomotic complications after McKeown esophagectomy.

Aims and methods: The purpose of this study was to prospectively evaluate the safety and efficacy of endoscopic examinations of the anastomotic region in the acute period after esophagectomy. Endoscopic examinations were performed on postoperative days (PODs) 1 and 8. The severity of ischemia was prospectively validated according to the endoscopic mucosal ischemic index (EMII).

Results: A total of 58 patients were included after evaluating the safety and feasibility of the endoscopic examination on POD 1 in 10 patients. Anastomotic leakage occurred in 6 patients. Stricture occurred in 13 patients. A greater than 67% circumference and lesion length greater than 20 mm of anastomotic ischemic area (AIA) on POD 1 were associated with developing anastomotic leakage after esophagectomy (OR: 14.5; 95% CI: 1.8-306.5; P = 0.03, OR: 19.4; 95% CI: 1.7-536.8; P = 0.03). More than 67% circumferential ischemic mucosa and ischemic mucosal lengths greater than 20 mm of AIA on POD 1 were associated with developing anastomotic strictures after esophagectomy (OR: 6.4; 95% CI: 1.4-31.7; P = 0.02, OR: 5.9; 95% CI: 1.2-33.1; P = 0.03). Patients with either more than 67% circumferential ischemic mucosa or ischemic mucosal lengths greater than 20 mm of AIA on POD 1 were defined as EMII-positive patients. The sensitivity, specificity, and positive and negative predictive values of EMII positivity on POD 1 for leakage were 100%, 78.8%, 35.3%, and 100%, respectively. The sensitivity, specificity, and positive and negative predictive values of the EMII positivity on POD 1 for strictures were 69.2%, 82.2%, 52.9%, and 90.2%, respectively.

Conclusions: The application of an endoscopic classification system to mucosal ischemia after McKeown esophagectomy is both appropriate and satisfactory in predicting anastomotic complications.

Trial registration: Clinical Trial.gov Registry, ID: NCT02937389, Registration date: Oct 17, 2015.

Keywords: Endoscopy; Esophageal cancer; Leakage; McKeown esophagectomy; Stricture.

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References

    1. Blencowe NS, Strong S, McNair AG et al (2012) Reporting of short-term clinical outcomes after esophagectomy: a systematic review. Ann Surg 255:658–666 - PubMed
    1. Raymond DP, Seder CW, Wright CD et al (2016) Predictors of major morbidity or mortality after resection for esophageal cancer: a society of thoracic surgeons general thoracic surgery database risk adjustment model. Ann Thorac Surg 102:207–214 - PubMed - PMC
    1. Dhungel B, Diggs BS, Hunter JG et al (2010) Patient and peri-operative predictors of morbidity and mortality after esophagectomy: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005–2008. J Gastrointest Surg 14:1492–1501 - PubMed
    1. Takeuchi H, Miyata H, Ozawa S et al (2017) Comparison of short-term outcomes between open and minimally invasive esophagectomy for esophageal cancer using a nationwide database in Japan. Ann Surg Oncol 24:1821–1827 - PubMed
    1. Biere SS, van Berge Henegouwen MI, Maas KW et al (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 379:1887–1892 - PubMed

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