Background
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.
Methods
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.
Results
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.
Conclusion
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.
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Article info
Publication history
Published online: August 09, 2016
Accepted:
June 18,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
