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Title:
Diagnosing Upper Gastrointestinal Anastomotic Leaks: Should Computed Tomography Be the Gold Standard?

Authors:
Dr. Med. Nader El-Sourani, Germany

Abstract:

Anastomotic leak following upper gastrointestinal surgery is the most feared complications in the postoperative setting. Therefore, it is of utmost importance to diagnose it in a timely and safely manner. The diagnostic algorithm, however, differs across institutions worldwide. The aim of this study was to analyse analyze whether computed tomography should be the gold standard in detecting or ruling out an anastomotic leak after upper gastrointestinal surgery.
Material and Methods: Records of 212 patients undergoing oesophagealesophageal surgery for underlying malignancy were analyzed. Out of those patients, all those diagnosed with an anastomotic leak through a diagnostic modality were included in this study and grouped according to the modality used. Continuous variables were exposed as medians. Categorical variables were compared using Fisher's exact test or chi-square test.
Results: 23 out of 212 patients were diagnosed with an anastomotic leak after oesophagealesophageal surgery. Between 2013 and 2017 routine examination of the oesophagusesophagus was carried out using a dynamic swallow study. This routine examination was abolished after 2017 and replaced by an on-demand examination through computed tomography and upper endoscopy. Computed tomography had a sensitivity of 100% compared to DSS with a sensitivity of 21.42%.
Conclusion: Computed tomography in combination with upper endoscopy should be the gold standard in detecting and treating an anastomotic leak after oesophagealesophageal surgery. There is no need for a routine examination in the post-operative setting. Diagnostic tools should only be used in the event of clinical symptoms or pre-sepsis/sepsis of the patient.

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