Computed Tomography Versus Water-Soluble Contrast Swallow in the Detection of Intrathoracic Anastomotic Leak Complicating Esophagogastrectomy (Ivor Lewis)

Abstract Background Traditionally many Upper-GI cancer tertiary centres have carried out contrast swallow fluoroscopic studies as a routine after Ivor-Lewis “Two-Stage” Oesophagectomy. However, more recently studies have demonstrated the limited value of this test as a routine screening study. The primary outcome of our study was to assess the sensitivity of routine contrast swallow in identifying anastomotic leak post oesophagectomy and identify how the study changed management of these patients. Methods This was a single-centre retrospective study involving 2-observer data collection. Data was collected and analysed from clinical notes for all patients who underwent an Ivor-Lewis oesophagectomy for cancer between January 2011 to December 2020. Results A total of 220 patients were identified. Protocol at the centre was to obtain a routine contrast swallow in the Fluoroscopy department on the fifth post-operative day– which occurred in 211 patients (96%). A total of 19 (8.64%) patients were diagnosed with an anastomotic leak (clinically and/or radiologically), with contrast swallow imaging and/or computed tomography (CT). There was no correlation between incidence of leak and T stage (p = 0.38) and N staging (p = 0.22). Only 3 of 19 anastomotic leaks were positively identified on contrast swallow study. All patients with anastomotic leak identified by contrast swallow study were asymptomatic i.e. “subclinical”. 2 patients were managed conservatively; one underwent endoscopic stent insertion. CT scan with oral contrast was the mode of diagnosis for 16 anastomotic leaks; where 10 patients underwent a CT scan following a normal contrast swallow study due to suspicious symptoms and 6 patients underwent expedited CT scans prior to Day-5 contrast swallow study due to presence of symptoms and limitation of fluoroscopy resources. The sensitivity of the Day-5 contrast swallow study was calculated to be 15.8% (CI 3.4, 39.6) with a specificity of 98.0% (CI 95.0, 99.5). Conclusions Our data reflects that routine contrast swallow study on Day-5 post Ivor-Lewis esophagectomy has a poor sensitivity in detecting anastomotic leak and may be falsely reassuring. The vast majority of patients had no change in management as a result of contrast swallow. This adds to the growing body of evidence limiting the role of contrast swallow in this situation. We recommend that clinical judgement and use of CT and endoscopy be the surgeon’s prime tools in the diagnosis of anastomotic leak post oesophagectomy.

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Comparative Study of Computed Tomography and Ventriculography with Water-Soluble Contrast Media

Proceedings of the XI. Symposium Neuroradiologicum ◽

10.1007/978-3-642-66959-0_170 ◽

1978 ◽

pp. 540-542

Author(s):

Nada Bešenski ◽

V. Gvozdanović ◽

V. Nutrizio ◽

S. Šimunić ◽

I. Jeličić ◽

...

Keyword(s):

Computed Tomography ◽

Comparative Study ◽

Contrast Media ◽

Water Soluble ◽

Water Soluble Contrast

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Diagnosis of Anastomotic Leak

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0041-1735270 ◽

2021 ◽

Vol 34 (06) ◽

pp. 391-399

Author(s):

Paul T. Hernandez ◽

Raj M. Paspulati ◽

Skandan Shanmugan

Keyword(s):

Anastomotic Leak ◽

Surgical Intervention ◽

Laboratory Data ◽

Water Soluble ◽

Contrast Study ◽

Anastomotic Leaks ◽

C Reactive Protein ◽

Reactive Protein ◽

Water Soluble Contrast ◽

The Impact

AbstractAnastomotic leaks after colorectal surgery is associated with increased morbidity and mortality. Understanding the impact of anastomotic leaks and their risk factors can help the surgeon avoid any modifiable pitfalls. The diagnosis of an anastomotic leak can be elusive but can be discerned by the patient's global clinical assessment, adjunctive laboratory data and radiological assessment. The use of inflammatory markers such as C-Reactive Protein and Procalcitonin have recently gained traction as harbingers for a leak. A CT scan and/or a water soluble contrast study can further elucidate the location and severity of a leak. Further intervention is then individualized on the spectrum of simple observation with resolution or surgical intervention.

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Role of Computed Tomography in the Radiological Evaluation of Painful Radiculopathy after Negative Myelography: Foraminal Neural Entrapment

Neurosurgery ◽

10.1227/00006123-198402000-00005 ◽

1984 ◽

Vol 14 (2) ◽

pp. 147-153 ◽

Cited By ~ 13

Author(s):

Dennis R. Osborne ◽

Ralph E. Heinz ◽

D. Bullard ◽

A. Friedman

Keyword(s):

Computed Tomography ◽

Water Soluble ◽

Vertebral Bone ◽

Lateral Recess ◽

Lateral Recess Stenosis ◽

Water Soluble Contrast ◽

Synovial Cysts ◽

Epidural Fat ◽

Prolapsed Disc

Abstract Thirty-five patients with an unremarkable or a negative water-soluble contrast myelogram and a diagnosis of foraminal neural entrapment made or more firmly established by computed tomography (CT) were detected in evaluating 950 patients presenting for myelography. The CT criterion of forminal neural entrapment was the presence of a mass displacing epidural fat and encroaching on the neural intervertebral foramen or lateral recess so as to compromise an emerging nerve root. The entrapment (confirmed operatively) was due to a laterally prolapsed disc (16 cases), superior articular hypertrophy (4 cases), lateral recess stenosis (3 cases), posterolateral vertebral bone lipping (2 cases), tumors (6 cases), postoperative scarring (2 cases), spondylolisthesis (1 case), and synovial cysts that encroached on the neural foramina (1 case). CT is an important additional investigation in patients with a painful radiculopathy and a negative or equivocal water-soluble contrast myelogram.

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