Serial Drain Amylase Can Accurately Detect Anastomotic Leak After Esophagectomy and May Facilitate Early Discharge

The Annals of Thoracic Surgery
Yaron PerryPhilip A Linden

Abstract

Anastomotic leaks after esophagectomy are a significant cause of postoperative morbidity and death. Barium esophagram and esophagogastroduodenoscopy are commonly used to survey for leaks; however, each has inherent risks and limitations. We sought to evaluate the effectiveness of daily drain amylase levels in detecting anastomotic leaks after esophagectomy. We retrospectively reviewed 146 consecutive patients who underwent esophagectomy with cervical and intrathoracic anastomosis using gastric conduit. We collected daily drain amylase levels and obtained postoperative barium esophagrams routinely. Receiver operating characteristic analysis was performed to evaluate the ability of drain amylase to detect anastomotic leaks and to determine the sensitivity and specificity at various cutoff values. There were no in-hospital or outpatient deaths within 30 days of operation in this consecutive series of patients. A leak occurred in 22 of 146 esophagectomy patients (15%) that required postoperative intervention. An additional 13 patients (9%) had a leak requiring only alteration of diet or antibiotics. The sensitivity and specificity for barium esophagram was 36.9% and 95%, respectively. For drain amylase obtained on postoperative day...Continue Reading

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References

Mar 5, 2009·The Journal of Thoracic and Cardiovascular Surgery·Cameron D WrightUNKNOWN Society of Thoracic Surgeons General Thoracic Surgery Database
May 30, 2009·Journal of the American College of Surgeons·James W MaherJohn M Kellum
Dec 4, 2012·The Annals of Thoracic Surgery·Richard D PageStephen H Pennefather
Apr 1, 2014·Journal of the American College of Surgeons·Jacqueline S IsraelSharon M Weber

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Citations

Apr 12, 2016·The Korean Journal of Thoracic and Cardiovascular Surgery·Simon RohKalpaj R Parekh
Dec 29, 2018·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Luca GiuliniHubert J Stein
May 15, 2018·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·B JiangC W Towe
Mar 20, 2019·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·R P T EvansE A Griffiths
Feb 5, 2019·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Woo Sik YuSeong Yong Park
May 8, 2018·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Judith P M SchotsGrard A P Nieuwenhuijzen
Mar 22, 2018·Arquivos De Gastroenterologia·Igor Braga RibeiroEverton Cazzo
Feb 11, 2021·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·Antonio BarbaroJonathan Shenfine
Mar 1, 2021·Esophagus : Official Journal of the Japan Esophageal Society·Tomohiro MatsumotoHiroya Takeuchi
Sep 30, 2021·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·Alexander BullJames A Gossage
Aug 27, 2021·The Annals of Thoracic Surgery·Philip A LindenYaron Perry

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