Early endoscopic assessment after esophagectomy can predict anastomotic complications: a novel scoring system

Oscar Åkesson, Isak Heyman, Jan Johansson, Pehr Rissler, Dan Falkenback

Research output: Contribution to journalArticlepeer-review


Background: Anastomotic leakage after esophagectomy is a serious and demanding complication. Early detection and treatment can probably prevent clinical deterioration of the patient. We have used early endoscopic assessment and a novel endoscopy score to predict anastomotic complications. Methods: 57 patients planned for Ivor Lewis esophagectomy were included. Endoscopy videos were recorded and biopsies were taken from the gastric conduit on day 7 or 8 after esophagectomy. A scoring system based on the endoscopic appearance, the combined endoscopy score (0–6), was developed. Scoring of the videos was done blinded. Patient outcome with regards to anastomotic complications was registered on postoperative day 30 in accordance with the ECCG definitions and compared to histopathology assessment and the combined endoscopy score retrospectively. Results: The rate of anastomotic defect (necrosis and leakage, ECCG definitions) was 19%. 7 out of 8 patients with a combined endoscopy score of ≥ 4 developed anastomotic defects. The combined endoscopy score was the only predictor for anastomotic complications. Conclusion: Prediction of anastomotic complications enables early detection and treatment which often limits the clinical extent of the complication. Early postoperative endoscopy is safe and a relatively simple procedure. The combined endoscopy score is an accurate tool to predict anastomotic complications.

Original languageEnglish
Pages (from-to)1903-1909
JournalSurgical Endoscopy
Issue number3
Early online date2021
Publication statusPublished - 2022

Subject classification (UKÄ)

  • Surgery

Free keywords

  • Anastomosis
  • Endoscopy
  • Esophagectomy
  • Leakage
  • Prediction


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