214 The Role of Water-Soluble Contrast Enemas in Assessing Anastomoses Prior to Ileostomy Reversal, and Their Influence on Patient Outcomes

Abstract

Abstract Aim Water-soluble contrast enemas (WSCE) are routinely performed to check anastomotic integrity and patency in patients who have undergone a low anterior resection and loop ileostomy formation, in preparation for subsequent ileostomy reversal. However, no specific guideline exists in this regard. Our aim was to evaluate whether WSCE influence management and patient outcomes. Method WSCE examinations performed between January 2019 to March 2021 were retrieved. Radiology reports, discharge summaries, and clinic letters were retrospectively collected from prospectively maintained data to determine outcomes. Results Over the 24-month period, we identified 63 patients who underwent a WSCE following an anterior resection. Seven had positive radiological leaks (11%), and six of these seven underwent further investigations, then either proceeded to a successful reversal (3) or are awaiting surgery (3). Additionally, WSCE identified 10 strictures (16%). Again, due to these findings, they underwent additional investigations before proceeding to interventions (ileostomy reversal, endoscopic dilatation, or resection of stenosed anastomosis). In total 30 patients (48%) underwent an ileostomy reversal. Only one (2%) was not successful due to a small bowel leak, not related to the low anastomosis. Conclusions This study demonstrates a positive WSCE result impacts subsequent investigations or interventions required. A positive result (leak or stricture) was never a contra-indication for reversal, and none of the positive results had significant postoperative complications. The only unsuccessful reversal was not related to the low anastomosis and had a normal WSCE. The exact investigations required, and their timeframe remains unclear, and we question whether radiological or endoluminal examinations should be routinely performed.