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

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Early endoscopic assessment after esophagectomy can predict anastomotic complications : a novel scoring system. / Åkesson, Oscar; Heyman, Isak; Johansson, Jan; Rissler, Pehr; Falkenback, Dan.

I: Surgical Endoscopy, 2021.

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskrift

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T1 - Early endoscopic assessment after esophagectomy can predict anastomotic complications

T2 - a novel scoring system

AU - Åkesson, Oscar

AU - Heyman, Isak

AU - Johansson, Jan

AU - Rissler, Pehr

AU - Falkenback, Dan

PY - 2021

Y1 - 2021

N2 - 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.

AB - 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.

KW - Anastomosis

KW - Endoscopy

KW - Esophagectomy

KW - Leakage

KW - Prediction

U2 - 10.1007/s00464-021-08472-4

DO - 10.1007/s00464-021-08472-4

M3 - Article

C2 - 33835253

AN - SCOPUS:85104150173

JO - Surgical Endoscopy

JF - Surgical Endoscopy

SN - 0930-2794

ER -