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Routine Radiologic Contrast Agent Examination After Gastrectomy for Gastric Cancer Is Not Useful

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Many studies have showed that routine upper gastrointestinal contrast agent examinations (RCE) for testing the patency of the anastomosis after esophagectomy or the stapler line after sleeve gastrectomy cannot be recommended due to low sensitivity. However, the clinical value of RCE after gastrectomy for gastric cancer remains unclear. We have retrospectively analyzed the clinical course of 377 consecutive patients who underwent gastrectomy for gastric cancer in our institution between 2005 and 2015. To date, we have performed a RCE on the fifth postoperative day before removal of the nasogastric tube and return to oral intake. In total, we have observed 14 anastomotic leaks (AL) (4%) after oncologic gastrectomy. Four AL (28.6%) occurred before the scheduled RCE on the fifth postoperative day (POD) and 7 (50%) late AL after POD 5. Three patients (21.4%) without any clinical symptoms were diagnosed by the RCE. Sensitivity of RCE was 50%. A significant percentage of patients with AL was diagnosed by computed tomography (CT) of the abdomen (50%). The standard therapy for AL after gastrectomy was endoscopic stent placement (n = 11), including three cases of stenting after surgical revision. Based on our data, we cannot recommend a RCE after gastrectomy for gastric cancer. The majority of AL occurs before or after a RCE and the sensitivity of the examination is low. In case of clinical suspicion of AL, a CT scan (with oral contrast agent) should be performed. In unclear cases, endoscopy is the preferable method providing the option of direct treatment.

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Acknowledgements

Dr. Struecker is participant in the BIH-Charité Clinical Scientist Program funded by the Charité – Universitätsmedizin Berlin and the Berlin Institute of Health.

Authors’ Contribution

All the authors meet all of the following criteria: substantial contributions to the conception, design of the work, the acquisition, analysis, and interpretation of data for the work; drafting the work and revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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    Authors and Affiliations

    1. Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

      Benjamin Struecker, Sascha Chopra, Ann-Christin Heilmann, Johanna Spenke, Christian Denecke, Igor M. Sauer, Marcus Bahra, Johann Pratschke, Andreas Andreou & Matthias Biebl

    2. Berlin Institute of Health (BIH), Berlin, Germany

      Benjamin Struecker

    3. Berlin School of Integrative Oncology, Berlin, Germany

      Andreas Andreou

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    1. Benjamin Struecker
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    Correspondence to Benjamin Struecker.

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    The authors declare that they have no conflicts of interest.

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    Andreas Andreou and Matthias Biebl contributed equally to this work.

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    Struecker, B., Chopra, S., Heilmann, AC. et al. Routine Radiologic Contrast Agent Examination After Gastrectomy for Gastric Cancer Is Not Useful. J Gastrointest Surg 21, 801–806 (2017). https://doi.org/10.1007/s11605-017-3384-3

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    • DOI: https://doi.org/10.1007/s11605-017-3384-3

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