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The clinical suspicion of a leaking intrathoracic esophagogastric anastomosis: the role of CT imaging

BACKGROUND: CT imaging is the primary diagnostic approach to assess the integrity of the intrathoracic anastomosis following Ivor Lewis esophagectomy. In the postoperative setting interpretation of CT findings, such as air and fluid collections, may be challenging. Establishment of a scoring system...

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Autores principales: Plat, Victor D., Bootsma, Boukje T., Straatman, Jennifer, van den Bergh, Janneke, van Waesberghe, Jan-Hein T. M., Luttikhold, Joanna, Luyer, Micha D. P., van der Peet, Donald L., Daams, Freek
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797855/
https://www.ncbi.nlm.nih.gov/pubmed/33447407
http://dx.doi.org/10.21037/jtd-20-954
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author Plat, Victor D.
Bootsma, Boukje T.
Straatman, Jennifer
van den Bergh, Janneke
van Waesberghe, Jan-Hein T. M.
Luttikhold, Joanna
Luyer, Micha D. P.
van der Peet, Donald L.
Daams, Freek
author_facet Plat, Victor D.
Bootsma, Boukje T.
Straatman, Jennifer
van den Bergh, Janneke
van Waesberghe, Jan-Hein T. M.
Luttikhold, Joanna
Luyer, Micha D. P.
van der Peet, Donald L.
Daams, Freek
author_sort Plat, Victor D.
collection PubMed
description BACKGROUND: CT imaging is the primary diagnostic approach to assess the integrity of the intrathoracic anastomosis following Ivor Lewis esophagectomy. In the postoperative setting interpretation of CT findings, such as air and fluid collections, may be challenging. Establishment of a scoring system that incorporates CT findings to diagnose anastomotic leakage could assist radiologists and surgeons in the postoperative phase. METHODS: Consecutive patients who underwent a CT scan for a clinical suspicion of postoperative anastomotic leakage following Ivor Lewis esophagectomy between 2010 and 2016 in two medical centers were retrospectively included. Scans were excluded when oral contrast was not (correctly) administered. Acquired images were randomized and independently assessed by two experienced gastrointestinal radiologists, blinded for clinical information. For this study anastomotic leakage was defined as a visible defect during endoscopy or thoracotomy. RESULTS: A total of 80 patients had 101 CT scans, resulting in 32 scans with a confirmed anastomotic leak (25 patients). After multivariable backward stepwise logistic regression, a practical 5-point scoring system was developed, which included the following CT findings: presence of extraluminal oral contrast, air collection at the anastomotic site, fluid collection at the anastomotic site, pneumothorax and loculated pleural effusion. Patients with a score of ≥3 were considered at high risk for anastomotic leakage (positive predictive value: 83.3%), patients with scores <3 were considered at low risk for anastomotic leakage (negative predictive value: 84.4%). The scoring system showed a superior diagnostic performance compared to the original CT report and blinded interpretation of two radiologists. CONCLUSIONS: Our CT-based practical scoring system enables a standardized approach in CT assessment and could facilitate early recognition of anastomotic leakage in patients after Ivor Lewis esophagectomy.
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spelling pubmed-77978552021-01-13 The clinical suspicion of a leaking intrathoracic esophagogastric anastomosis: the role of CT imaging Plat, Victor D. Bootsma, Boukje T. Straatman, Jennifer van den Bergh, Janneke van Waesberghe, Jan-Hein T. M. Luttikhold, Joanna Luyer, Micha D. P. van der Peet, Donald L. Daams, Freek J Thorac Dis Original Article BACKGROUND: CT imaging is the primary diagnostic approach to assess the integrity of the intrathoracic anastomosis following Ivor Lewis esophagectomy. In the postoperative setting interpretation of CT findings, such as air and fluid collections, may be challenging. Establishment of a scoring system that incorporates CT findings to diagnose anastomotic leakage could assist radiologists and surgeons in the postoperative phase. METHODS: Consecutive patients who underwent a CT scan for a clinical suspicion of postoperative anastomotic leakage following Ivor Lewis esophagectomy between 2010 and 2016 in two medical centers were retrospectively included. Scans were excluded when oral contrast was not (correctly) administered. Acquired images were randomized and independently assessed by two experienced gastrointestinal radiologists, blinded for clinical information. For this study anastomotic leakage was defined as a visible defect during endoscopy or thoracotomy. RESULTS: A total of 80 patients had 101 CT scans, resulting in 32 scans with a confirmed anastomotic leak (25 patients). After multivariable backward stepwise logistic regression, a practical 5-point scoring system was developed, which included the following CT findings: presence of extraluminal oral contrast, air collection at the anastomotic site, fluid collection at the anastomotic site, pneumothorax and loculated pleural effusion. Patients with a score of ≥3 were considered at high risk for anastomotic leakage (positive predictive value: 83.3%), patients with scores <3 were considered at low risk for anastomotic leakage (negative predictive value: 84.4%). The scoring system showed a superior diagnostic performance compared to the original CT report and blinded interpretation of two radiologists. CONCLUSIONS: Our CT-based practical scoring system enables a standardized approach in CT assessment and could facilitate early recognition of anastomotic leakage in patients after Ivor Lewis esophagectomy. AME Publishing Company 2020-12 /pmc/articles/PMC7797855/ /pubmed/33447407 http://dx.doi.org/10.21037/jtd-20-954 Text en 2020 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Plat, Victor D.
Bootsma, Boukje T.
Straatman, Jennifer
van den Bergh, Janneke
van Waesberghe, Jan-Hein T. M.
Luttikhold, Joanna
Luyer, Micha D. P.
van der Peet, Donald L.
Daams, Freek
The clinical suspicion of a leaking intrathoracic esophagogastric anastomosis: the role of CT imaging
title The clinical suspicion of a leaking intrathoracic esophagogastric anastomosis: the role of CT imaging
title_full The clinical suspicion of a leaking intrathoracic esophagogastric anastomosis: the role of CT imaging
title_fullStr The clinical suspicion of a leaking intrathoracic esophagogastric anastomosis: the role of CT imaging
title_full_unstemmed The clinical suspicion of a leaking intrathoracic esophagogastric anastomosis: the role of CT imaging
title_short The clinical suspicion of a leaking intrathoracic esophagogastric anastomosis: the role of CT imaging
title_sort clinical suspicion of a leaking intrathoracic esophagogastric anastomosis: the role of ct imaging
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797855/
https://www.ncbi.nlm.nih.gov/pubmed/33447407
http://dx.doi.org/10.21037/jtd-20-954
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