The Diagnostic Dilemma of Anastomotic Leak in Esophagogastric Surgery

Study Overview
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Brief Summary
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To study the diagnostic specificity and sensitivity of various modalities used for the assessment of anastomotic leak in esophagogastric surgery and to identify the most sensitive technique. Secondarily, to propose a clinical algorithm to guide clinicians in the diagnosis of anastomotic leaks esophagogastric surgeries.

Detailed Description
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Anastomotic leak in esophagogastric surgery remains a diagnostic challenge despite advances in imaging techniques. All available modalities appear to have limited sensitivities and have significant false negatives. A high index of clinical suspicion continues to be the key element in the early diagnosis of esophagogastric anastomotic leaks. The incidence of anastomotic leak in esophagogastric surgeries is reported to range from 7-20% in various studies, and it is a major complication that increases hospital stay and mortality. It is important to identify these complications early to optimize the outcomes of these patients. There has been no study till date that examines the incidence of false negative results for anastomotic leak in esophagogastric surgeries. False negative findings may give surgeons a false sense of assurance in the patient's postoperative recovery, and escalation of oral intake may result in catastrophic complications and outcomes in these patients. This study seeks to identify the most sensitive modality in the diagnosis of esophagogastric anastomotic leaks in a retrospective series of patients.

Official Title
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The Diagnostic Dilemma of Anastomotic Leak in Esophagogastric Surgery: Is it Safe to Feed the Patient?

Conditions
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Anastomotic Leak

Intervention / Treatment
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* Procedure: Esophageal and gastric resections requiring an anastomosis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing any of the following surgeries at National University Hospital, Singapore between January 2001 and March 2019: Distal gastrectomies Total gastrectomies Bariatric gastric bypasses Subtotal esophagectomies Proximal gastrectomies Palliative bypasses Total esophagectomies Exclusion Criteria: Under 21 years of age

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Esophagogastric Surgery Patients<br>Patients who underwent esophageal and gastric resections requiring an anastomosis from January 2001 to March 2019 | Procedure: Esophageal and gastric resections requiring an anastomosis<br>* Distal gastrectomies, total gastrectomies, bariatric gastric bypasses, subtotal esophagectomies, proximal gastrectomies, palliative bypasses, and total esophagectomies.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Anastomotic leak | To identify key clinical parameters that are predictive of anastomotic leak and to evaluate the effectiveness of various investigations for diagnosing anastomotic leak following upper gastrointestinal surgeries involving anastomosis | Surgery day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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anastomotic leak, esophagogastric surgery, bariatric surgery, anastamosis