Early postoperative endoscopy for targeted management of patients at risks of anastomotic complications after esophagectomy
Background Early postoperative endoscopy after esophagectomy is assumed to be effective in detection and prediction of anastomotic complications, but overall effects of early postoperative endoscopy remain uncertain. The aim of this study was to investigate whether mucosal status assessed by early p...
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| Veröffentlicht in: | Surgery 2016-11, Vol.160 (5), p.1294-1301 |
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| creator | Nishikawa, Katsunori, MD Fujita, Tetsuji, MD Yuda, Masami, MD Yamamoto, SeRyung, MD Tanaka, Yujiro, MD Matsumoto, Akira, MD Tanishima, Yuichiro, MD Yano, Fumiaki, MD Mitsumori, Norio, MD Yanaga, Katsuhiko, MD |
| description | Background Early postoperative endoscopy after esophagectomy is assumed to be effective in detection and prediction of anastomotic complications, but overall effects of early postoperative endoscopy remain uncertain. The aim of this study was to investigate whether mucosal status assessed by early postoperative endoscopy could offer an approach to individualized management after esophagectomy. Methods Endoscopy was performed in 176 of 214 patients who underwent esophagectomy at either 1 week or 2 weeks postoperatively. Mucosal damage in the proximal region of the graft was classified as follows: intact mucosa, mild mucosal degeneration, and severe mucosal degeneration. We examined the association of the severity of mucosal damage and the incidence of anastomotic complications. Results Twenty-eight patients (16%) developed anastomotic stricture. Symptomatic anastomotic leaks occurred in 15 patients (8.5%), including 6 with stricture. The frequency of intact mucosa, mild mucosal degeneration, and severe mucosal was 7%, 20%, and 73% for leaks; 4%, 11%, and 85% for strictures; and 28%, 62%, and 10% for no complications, respectively ( P |
| doi_str_mv | 10.1016/j.surg.2016.06.022 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1835689185</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0039606016302975</els_id><sourcerecordid>1835689185</sourcerecordid><originalsourceid>FETCH-LOGICAL-c411t-39e1a396bf237ed7b83614fcee0ed194a471fc9fe055dd1920da07c8604d592c3</originalsourceid><addsrcrecordid>eNp9kU2LFDEQhoMo7rj6BzxIjl56rCT9CSLIsroLCx7Uc8gk1WNmuzttkl5o_PNWM6sHD0JBQvHUC_UUY68F7AWI-t1pn5Z43Ev674FKyidsJyoli0bV4inbAaiuqKGGC_YipRMAdKVon7ML2VRSQFnt2K9rE4eVzyHlMGM02T8gx8mFZMO88j5Enk08YkbHRzOZI444ZR56PhNL38RN5tGn-7Q1iaCgMWRvuQ3jPHhLWJiI6jNGjinMPyjEErS-ZM96MyR89fhesu-frr9d3RR3Xz7fXn28K2wpRC5Uh8Korj70UjXomkNL25W9RQR0oitN2Yjedj1CVTlqSHAGGtvWULqqk1Zdsrfn3DmGnwumrEefLA6DmTAsSYtWVXXbibYiVJ5RG0NKEXs9Rz-auGoBepOuT3qTrjfpGqikpKE3j_nLYUT3d-SPZQLenwGkLR88Rp0subPofCQV2gX___wP_4zbwU9kdrjHFdMpLHEif1roJDXor9vZt6uLWoHsmkr9Bsd-q4E</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1835689185</pqid></control><display><type>article</type><title>Early postoperative endoscopy for targeted management of patients at risks of anastomotic complications after esophagectomy</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Nishikawa, Katsunori, MD ; Fujita, Tetsuji, MD ; Yuda, Masami, MD ; Yamamoto, SeRyung, MD ; Tanaka, Yujiro, MD ; Matsumoto, Akira, MD ; Tanishima, Yuichiro, MD ; Yano, Fumiaki, MD ; Mitsumori, Norio, MD ; Yanaga, Katsuhiko, MD</creator><creatorcontrib>Nishikawa, Katsunori, MD ; Fujita, Tetsuji, MD ; Yuda, Masami, MD ; Yamamoto, SeRyung, MD ; Tanaka, Yujiro, MD ; Matsumoto, Akira, MD ; Tanishima, Yuichiro, MD ; Yano, Fumiaki, MD ; Mitsumori, Norio, MD ; Yanaga, Katsuhiko, MD</creatorcontrib><description>Background Early postoperative endoscopy after esophagectomy is assumed to be effective in detection and prediction of anastomotic complications, but overall effects of early postoperative endoscopy remain uncertain. The aim of this study was to investigate whether mucosal status assessed by early postoperative endoscopy could offer an approach to individualized management after esophagectomy. Methods Endoscopy was performed in 176 of 214 patients who underwent esophagectomy at either 1 week or 2 weeks postoperatively. Mucosal damage in the proximal region of the graft was classified as follows: intact mucosa, mild mucosal degeneration, and severe mucosal degeneration. We examined the association of the severity of mucosal damage and the incidence of anastomotic complications. Results Twenty-eight patients (16%) developed anastomotic stricture. Symptomatic anastomotic leaks occurred in 15 patients (8.5%), including 6 with stricture. The frequency of intact mucosa, mild mucosal degeneration, and severe mucosal was 7%, 20%, and 73% for leaks; 4%, 11%, and 85% for strictures; and 28%, 62%, and 10% for no complications, respectively ( P <.001). Asymptomatic leaks were found in 4 patients in the 1-week endoscopy group. Sensitivity and specificity for the development of stricture in 1-week/2-week were 0.88/0.83 and 0.85/0.98, respectively. Positive and negative predictive values were 0.52/0.91 and 0.97/0.96, respectively. Early postoperative endoscopy could be carried out without any adverse events in all patients. Conclusion Assessment of the anastomosis and graft with early postoperative endoscopy was safe and resulted in a high predictive value for subsequent anastomotic complications. Early postoperative endoscopy may lead to targeted management for a subset of patients undergoing esophagectomy.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2016.06.022</identifier><identifier>PMID: 27521045</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical - adverse effects ; Anastomosis, Surgical - methods ; Anastomotic Leak - diagnosis ; Anastomotic Leak - etiology ; Anastomotic Leak - therapy ; Cohort Studies ; Esophageal Neoplasms - mortality ; Esophageal Neoplasms - pathology ; Esophageal Neoplasms - surgery ; Esophageal Stenosis - diagnosis ; Esophageal Stenosis - etiology ; Esophageal Stenosis - therapy ; Esophagectomy - adverse effects ; Esophagectomy - methods ; Esophagoscopy - methods ; Female ; Follow-Up Studies ; Humans ; Japan ; Male ; Middle Aged ; Patient Safety ; Postoperative Care - methods ; Predictive Value of Tests ; Retrospective Studies ; Risk Assessment ; Surgery ; Time Factors ; Treatment Outcome</subject><ispartof>Surgery, 2016-11, Vol.160 (5), p.1294-1301</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-39e1a396bf237ed7b83614fcee0ed194a471fc9fe055dd1920da07c8604d592c3</citedby><cites>FETCH-LOGICAL-c411t-39e1a396bf237ed7b83614fcee0ed194a471fc9fe055dd1920da07c8604d592c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.surg.2016.06.022$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27521045$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nishikawa, Katsunori, MD</creatorcontrib><creatorcontrib>Fujita, Tetsuji, MD</creatorcontrib><creatorcontrib>Yuda, Masami, MD</creatorcontrib><creatorcontrib>Yamamoto, SeRyung, MD</creatorcontrib><creatorcontrib>Tanaka, Yujiro, MD</creatorcontrib><creatorcontrib>Matsumoto, Akira, MD</creatorcontrib><creatorcontrib>Tanishima, Yuichiro, MD</creatorcontrib><creatorcontrib>Yano, Fumiaki, MD</creatorcontrib><creatorcontrib>Mitsumori, Norio, MD</creatorcontrib><creatorcontrib>Yanaga, Katsuhiko, MD</creatorcontrib><title>Early postoperative endoscopy for targeted management of patients at risks of anastomotic complications after esophagectomy</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background Early postoperative endoscopy after esophagectomy is assumed to be effective in detection and prediction of anastomotic complications, but overall effects of early postoperative endoscopy remain uncertain. The aim of this study was to investigate whether mucosal status assessed by early postoperative endoscopy could offer an approach to individualized management after esophagectomy. Methods Endoscopy was performed in 176 of 214 patients who underwent esophagectomy at either 1 week or 2 weeks postoperatively. Mucosal damage in the proximal region of the graft was classified as follows: intact mucosa, mild mucosal degeneration, and severe mucosal degeneration. We examined the association of the severity of mucosal damage and the incidence of anastomotic complications. Results Twenty-eight patients (16%) developed anastomotic stricture. Symptomatic anastomotic leaks occurred in 15 patients (8.5%), including 6 with stricture. The frequency of intact mucosa, mild mucosal degeneration, and severe mucosal was 7%, 20%, and 73% for leaks; 4%, 11%, and 85% for strictures; and 28%, 62%, and 10% for no complications, respectively ( P <.001). Asymptomatic leaks were found in 4 patients in the 1-week endoscopy group. Sensitivity and specificity for the development of stricture in 1-week/2-week were 0.88/0.83 and 0.85/0.98, respectively. Positive and negative predictive values were 0.52/0.91 and 0.97/0.96, respectively. Early postoperative endoscopy could be carried out without any adverse events in all patients. Conclusion Assessment of the anastomosis and graft with early postoperative endoscopy was safe and resulted in a high predictive value for subsequent anastomotic complications. Early postoperative endoscopy may lead to targeted management for a subset of patients undergoing esophagectomy.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anastomosis, Surgical - adverse effects</subject><subject>Anastomosis, Surgical - methods</subject><subject>Anastomotic Leak - diagnosis</subject><subject>Anastomotic Leak - etiology</subject><subject>Anastomotic Leak - therapy</subject><subject>Cohort Studies</subject><subject>Esophageal Neoplasms - mortality</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophageal Stenosis - diagnosis</subject><subject>Esophageal Stenosis - etiology</subject><subject>Esophageal Stenosis - therapy</subject><subject>Esophagectomy - adverse effects</subject><subject>Esophagectomy - methods</subject><subject>Esophagoscopy - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Japan</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patient Safety</subject><subject>Postoperative Care - methods</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU2LFDEQhoMo7rj6BzxIjl56rCT9CSLIsroLCx7Uc8gk1WNmuzttkl5o_PNWM6sHD0JBQvHUC_UUY68F7AWI-t1pn5Z43Ev674FKyidsJyoli0bV4inbAaiuqKGGC_YipRMAdKVon7ML2VRSQFnt2K9rE4eVzyHlMGM02T8gx8mFZMO88j5Enk08YkbHRzOZI444ZR56PhNL38RN5tGn-7Q1iaCgMWRvuQ3jPHhLWJiI6jNGjinMPyjEErS-ZM96MyR89fhesu-frr9d3RR3Xz7fXn28K2wpRC5Uh8Korj70UjXomkNL25W9RQR0oitN2Yjedj1CVTlqSHAGGtvWULqqk1Zdsrfn3DmGnwumrEefLA6DmTAsSYtWVXXbibYiVJ5RG0NKEXs9Rz-auGoBepOuT3qTrjfpGqikpKE3j_nLYUT3d-SPZQLenwGkLR88Rp0subPofCQV2gX___wP_4zbwU9kdrjHFdMpLHEif1roJDXor9vZt6uLWoHsmkr9Bsd-q4E</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>Nishikawa, Katsunori, MD</creator><creator>Fujita, Tetsuji, MD</creator><creator>Yuda, Masami, MD</creator><creator>Yamamoto, SeRyung, MD</creator><creator>Tanaka, Yujiro, MD</creator><creator>Matsumoto, Akira, MD</creator><creator>Tanishima, Yuichiro, MD</creator><creator>Yano, Fumiaki, MD</creator><creator>Mitsumori, Norio, MD</creator><creator>Yanaga, Katsuhiko, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20161101</creationdate><title>Early postoperative endoscopy for targeted management of patients at risks of anastomotic complications after esophagectomy</title><author>Nishikawa, Katsunori, MD ; Fujita, Tetsuji, MD ; Yuda, Masami, MD ; Yamamoto, SeRyung, MD ; Tanaka, Yujiro, MD ; Matsumoto, Akira, MD ; Tanishima, Yuichiro, MD ; Yano, Fumiaki, MD ; Mitsumori, Norio, MD ; Yanaga, Katsuhiko, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-39e1a396bf237ed7b83614fcee0ed194a471fc9fe055dd1920da07c8604d592c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anastomosis, Surgical - adverse effects</topic><topic>Anastomosis, Surgical - methods</topic><topic>Anastomotic Leak - diagnosis</topic><topic>Anastomotic Leak - etiology</topic><topic>Anastomotic Leak - therapy</topic><topic>Cohort Studies</topic><topic>Esophageal Neoplasms - mortality</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophageal Stenosis - diagnosis</topic><topic>Esophageal Stenosis - etiology</topic><topic>Esophageal Stenosis - therapy</topic><topic>Esophagectomy - adverse effects</topic><topic>Esophagectomy - methods</topic><topic>Esophagoscopy - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Japan</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patient Safety</topic><topic>Postoperative Care - methods</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nishikawa, Katsunori, MD</creatorcontrib><creatorcontrib>Fujita, Tetsuji, MD</creatorcontrib><creatorcontrib>Yuda, Masami, MD</creatorcontrib><creatorcontrib>Yamamoto, SeRyung, MD</creatorcontrib><creatorcontrib>Tanaka, Yujiro, MD</creatorcontrib><creatorcontrib>Matsumoto, Akira, MD</creatorcontrib><creatorcontrib>Tanishima, Yuichiro, MD</creatorcontrib><creatorcontrib>Yano, Fumiaki, MD</creatorcontrib><creatorcontrib>Mitsumori, Norio, MD</creatorcontrib><creatorcontrib>Yanaga, Katsuhiko, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nishikawa, Katsunori, MD</au><au>Fujita, Tetsuji, MD</au><au>Yuda, Masami, MD</au><au>Yamamoto, SeRyung, MD</au><au>Tanaka, Yujiro, MD</au><au>Matsumoto, Akira, MD</au><au>Tanishima, Yuichiro, MD</au><au>Yano, Fumiaki, MD</au><au>Mitsumori, Norio, MD</au><au>Yanaga, Katsuhiko, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early postoperative endoscopy for targeted management of patients at risks of anastomotic complications after esophagectomy</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>160</volume><issue>5</issue><spage>1294</spage><epage>1301</epage><pages>1294-1301</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><abstract>Background Early postoperative endoscopy after esophagectomy is assumed to be effective in detection and prediction of anastomotic complications, but overall effects of early postoperative endoscopy remain uncertain. The aim of this study was to investigate whether mucosal status assessed by early postoperative endoscopy could offer an approach to individualized management after esophagectomy. Methods Endoscopy was performed in 176 of 214 patients who underwent esophagectomy at either 1 week or 2 weeks postoperatively. Mucosal damage in the proximal region of the graft was classified as follows: intact mucosa, mild mucosal degeneration, and severe mucosal degeneration. We examined the association of the severity of mucosal damage and the incidence of anastomotic complications. Results Twenty-eight patients (16%) developed anastomotic stricture. Symptomatic anastomotic leaks occurred in 15 patients (8.5%), including 6 with stricture. The frequency of intact mucosa, mild mucosal degeneration, and severe mucosal was 7%, 20%, and 73% for leaks; 4%, 11%, and 85% for strictures; and 28%, 62%, and 10% for no complications, respectively ( P <.001). Asymptomatic leaks were found in 4 patients in the 1-week endoscopy group. Sensitivity and specificity for the development of stricture in 1-week/2-week were 0.88/0.83 and 0.85/0.98, respectively. Positive and negative predictive values were 0.52/0.91 and 0.97/0.96, respectively. Early postoperative endoscopy could be carried out without any adverse events in all patients. Conclusion Assessment of the anastomosis and graft with early postoperative endoscopy was safe and resulted in a high predictive value for subsequent anastomotic complications. Early postoperative endoscopy may lead to targeted management for a subset of patients undergoing esophagectomy.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27521045</pmid><doi>10.1016/j.surg.2016.06.022</doi><tpages>8</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Anastomosis, Surgical - adverse effects Anastomosis, Surgical - methods Anastomotic Leak - diagnosis Anastomotic Leak - etiology Anastomotic Leak - therapy Cohort Studies Esophageal Neoplasms - mortality Esophageal Neoplasms - pathology Esophageal Neoplasms - surgery Esophageal Stenosis - diagnosis Esophageal Stenosis - etiology Esophageal Stenosis - therapy Esophagectomy - adverse effects Esophagectomy - methods Esophagoscopy - methods Female Follow-Up Studies Humans Japan Male Middle Aged Patient Safety Postoperative Care - methods Predictive Value of Tests Retrospective Studies Risk Assessment Surgery Time Factors Treatment Outcome |
| title | Early postoperative endoscopy for targeted management of patients at risks of anastomotic complications after esophagectomy |
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