Early postoperative endoscopy for targeted management of patients at risks of anastomotic complications after esophagectomy
| Autor: | Yuichiro Tanishima, Se-Ryung Yamamoto, Katsuhiko Yanaga, Fumiaki Yano, Tetsuji Fujita, Yujiro Tanaka, Norio Mitsumori, Akira Matsumoto, Masami Yuda, Katsunori Nishikawa |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Esophageal Neoplasms medicine.medical_treatment Anastomotic Leak 030230 surgery Anastomosis Gastroenterology Risk Assessment Cohort Studies 03 medical and health sciences 0302 clinical medicine Japan Predictive Value of Tests Anastomotic leaks Internal medicine medicine Humans Aged Retrospective Studies Aged 80 and over Postoperative Care medicine.diagnostic_test business.industry Incidence (epidemiology) Anastomosis Surgical Retrospective cohort study Middle Aged Endoscopy Surgery Esophagectomy Treatment Outcome Predictive value of tests Esophageal Stenosis 030211 gastroenterology & hepatology Female Esophagoscopy Patient Safety business Cohort study Follow-Up Studies |
| Zdroj: | Surgery. 160(5) |
| ISSN: | 1532-7361 |
| Popis: | Early postoperative endoscopy after esophagectomy is assumed to be effective in detection and prediction of anastomotic complications, but overall effects of early postoperative endoscopy remain uncertain. The aim of this study was to investigate whether mucosal status assessed by early postoperative endoscopy could offer an approach to individualized management after esophagectomy.Endoscopy was performed in 176 of 214 patients who underwent esophagectomy at either 1 week or 2 weeks postoperatively. Mucosal damage in the proximal region of the graft was classified as follows: intact mucosa, mild mucosal degeneration, and severe mucosal degeneration. We examined the association of the severity of mucosal damage and the incidence of anastomotic complications.Twenty-eight patients (16%) developed anastomotic stricture. Symptomatic anastomotic leaks occurred in 15 patients (8.5%), including 6 with stricture. The frequency of intact mucosa, mild mucosal degeneration, and severe mucosal was 7%, 20%, and 73% for leaks; 4%, 11%, and 85% for strictures; and 28%, 62%, and 10% for no complications, respectively (P.001). Asymptomatic leaks were found in 4 patients in the 1-week endoscopy group. Sensitivity and specificity for the development of stricture in 1-week/2-week were 0.88/0.83 and 0.85/0.98, respectively. Positive and negative predictive values were 0.52/0.91 and 0.97/0.96, respectively. Early postoperative endoscopy could be carried out without any adverse events in all patients.Assessment of the anastomosis and graft with early postoperative endoscopy was safe and resulted in a high predictive value for subsequent anastomotic complications. Early postoperative endoscopy may lead to targeted management for a subset of patients undergoing esophagectomy. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect