Ultrathin endoscopy versus computed tomography in the detection of anastomotic leak in the early period after esophagectomy

Abstract

BackgroundAnastomotic leak after esophagectomy is a major postoperative complication that leads to significant mortality. The aim of this study was to evaluate the safety of early postoperative ultrathin endoscopy in detecting anastomotic leaks and compare diagnostic performance of ultrathin endoscopy and computed tomography (CT) scan in identifying anastomotic leak after esophagectomy. Materials and methodsA prospective trial of 71 patients undergoing esophagectomy was conducted between January 2016 to December 2017. A contrast CT was performed prior to ultrathin endoscopy on postoperative day 5–7. ResultsAll 71 patients underwent ultrathin endoscopy and CT scan safely without complications. Among the 71 patients, transoral ultrathin endoscopy was performed on 51 patients and 20 patients with hypertension and coronary artery disease received transnasal ultrathin endoscopy. Overall, 14 leaks (20%) were identified. Endoscopy not only correctly identified the 2 patients of false-positive evaluations by CT, but also determined 4 leaks that were missed on CT. In addition, ultrathin endoscopy accurately identified 3 potential leaks based on pathological findings of anastomosis: ischemia and much fibrin coverings. One patient with normal postoperative CT findings showed healthy anastomosis but an ulcer on gastric conduit on endoscopy. Both sensitivity and specificity of endoscopy were 100%, while sensitivity and specificity of CT were 71.4% and 96.5%. ConclusionsUltrathin endoscopy after esophagectomy is safe and provides more accurate and reliable identification of anastomotic leak than CT scan. Ultrathin transnasal endoscopy may be a more appropriate diagnostic test to detect anastomosis for patients with hypertension and coronary artery disease.