The safety and usefulness of endoscopy for evaluation of the graft and anastomosis early after esophagectomy and reconstruction

• Published in: Surgical endoscopy Vol. 19; no. 8; pp. 1093 - 1102
• Main Authors: MAISH, M. S, DEMEESTER, S. R, CHOUSTOULAKIS, E, BRIEL, J. W, HAGEN, J. A, PETERS, J. H, LIPHAM, J. C, BREMNER, C. G, DEMEESTER, T. R
• Format: Journal Article
• Language: English
• Published: New York, NY Springer 01.08.2005; Springer Nature B.V
• Subjects: Aged; Anastomosis, Surgical - adverse effects; Biological and medical sciences; Endoscopy; Esophagectomy - adverse effects; Esophagoscopy; Esophagus; Esophagus - blood supply; Esophagus - surgery; Female; General aspects; Humans; Intestines - blood supply; Intestines - transplantation; Ischemia; Ischemia - diagnosis; Male; Medical sciences; Middle Aged; Patients; Postoperative Care; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Reoperation; Retrospective Studies; Safety; Surgeons; Surgical anastomosis; Time Factors; Los Angeles California; United States > US; Medicine; Ischemia; Esophagectomy; Cardiovascular disease; Graft; Endoscopy; Graft ischemia; Esophageal reconstruction; Necrosis; Esophagus
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-004-8816-y

Although rare, graft ischemia and necrosis after esophagectomy is a devastating complication. The aim of this study was to review our experience with early endoscopy for evaluation of the graft and anastomosis after esophagectomy and reconstruction. From a population of 479 patients who underwent esophagectomy during the years 1996-2003, we identified 102 patients who had endoscopy within 21 days of operation. Endoscopy was performed a median of 9 days after operation. Graft ischemia, anastomotic leak, or both were found in 63 of the 102 patients. Reoperation was necessary in 27% of these patients, including graft removal in nine patients. In 39 patients, endoscopy demonstrated a healthy graft; only one of these patients (2.6%) required reoperation. No patient with ischemia judged insufficient to warrant graft removal on initial endoscopy subsequently lost their graft. There were no complications or anastomotic injuries associated with early endoscopy. Endoscopy early after esophagectomy is safe and provides accurate and reliable identification of graft ischemia that can be used to guide the treatment of these patients.