Early Postoperative Endoscopy for Evaluation of the Anastomosis after Esophageal Reconstruction
| Autor: | Pei-Ming Huang, Tzu-Hsin Lin |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Leak Torsion Abnormality Necrosis Time Factors Esophageal Neoplasms Ischemia Anastomotic Leak Anastomosis 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests medicine Humans Aged Gastrostomy Wound Healing medicine.diagnostic_test business.industry Anastomosis Surgical Reproducibility of Results Esophageal cancer Middle Aged Plastic Surgery Procedures medicine.disease Surgery Endoscopy Esophagectomy Stenosis Treatment Outcome ROC Curve 030220 oncology & carcinogenesis Predictive value of tests Area Under Curve Esophageal Stenosis 030211 gastroenterology & hepatology Female Radiology Esophagoscopy medicine.symptom Cardiology and Cardiovascular Medicine business Esophagostomy |
| Zdroj: | The Thoracic and cardiovascular surgeon. 66(5) |
| ISSN: | 1439-1902 |
| Popis: | Background Anastomotic leaks significantly affect hospital stay after esophageal surgery. Here, we investigated the efficacy of early endoscopy for predicting anastomotic healing and leaks after esophageal reconstruction. Methods A total of 65 consecutive esophageal cancer patients treated by cervical esophagogastrostomy underwent routine endoscopy between postoperative days 5 and 7. The anastomosis was scored for the degree of ischemia, stenosis, and torsion of the anastomotic axis. Independent associations between ischemia, stenosis, and torsion of the proximal esophagus and the risk of the anastomotic leak were examined using Spearman's rank correlation method. Results Assessment of the degree of mucosal ischemia in 65 patients shows well healing in 35, patch ischemia in 20, diffuse ischemia in 10, no necrosis in any patient. Stenosis was classified as 0 to 10% in 40 patients, 11 to 20% in 12, 21 to 80% in 11, and 81 to 100% in 2. The degree of torsion of the anastomotic axis was classified as 0 to 10 degrees in 52 patients, 11 to 90 degrees in 8, and 91 to 180 degrees in 5. With rising endoscopy scores, there was an increase in risk for leaks (score > 4.5, sensitivity 100%, and specificity 83.8%). Conclusions Early postoperative endoscopy facilitates the management of esophagogastrostomy anastomosis to predict leaks. |
| Databáze: | OpenAIRE |
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