Endoscopic Assessment 1 Day After Esophagectomy for Predicting Cervical Esophagogastric Anastomosis-relating Complications

Background: There are no useful methods for predicting anastomosis-relating complications after esophagectomy; however, anastomotic leakage remains one of the most serious postoperative complications. We retrospectively investigated the appropriateness of endoscopic examinations on postoperative day 1 (POD 1) for assessing esophageal reconstruction by analyzing the endoscopic findings 1 day after the operation and evaluating the healing process at the site of anastomosis in patients treated with esophageal reconstruction.

Methods: Between 2010 and 2013, we performed esophageal reconstructive surgery using a retrosternal gastric graft and cervical anastomosis and conducted endoscopic examinations to assess the esophagogastric anastomosis on POD 1 in 153 patients. On endoscopy performed on POD 1, we identified mucosal color change (MCC) in the proximal gastric graft as an important finding that may be indicative of local circulatory failure in gastric grafts. One week after the operation, endoscopic examinations subsequently showed significant mucosal defects around the site of anastomosis that were expected to result in anastomotic leakage as a marker of poor healing of anastomosis as well as leakage.

Results: We identified the findings of MCC in 36 patients evaluated with endoscopic examinations performed on POD 1. Furthermore, the endoscopic examinations performed 1 week after the operation revealed poor healing of the anastomosis site in 23 patients, including one patient with major anastomotic leakage. Therefore, poor healing of the anastomosis site more frequently occurred in 20 of the 36 patients (55.6%) who exhibited MCC on the endoscopic examinations performed on POD 1 than in three of the 117 patients (2.6%) who had normal endoscopic findings on POD 1 (p < 0.001).

Conclusions: Early endoscopy performed on POD 1 helps to predict the development of poor healing of esophagogastric anastomosis around 1 week after the operation by identifying the findings of MCC in the proximal gastric graft.