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Prospective study of routine contrast radiology after total gastrectomy

Lookup NU author(s): Dr Peter Lamb, Professor Michael Griffin, Dr David Richardson, Dr Daya Karat, Nick Hayes

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Abstract

Background: The practice of routine contrast radiology before recommencing oral nutrition after total gastrectomy is not evidence based. The aim of this prospective study was to evaluate the clinical role and timing of this investigation. Methods: Seventy-six consecutive patients underwent total gastrectomy with a stapled oesophagojejunal anastomosis. A contrast swallow using non-ionic contrast and barium was performed routinely 5 and 9 days after surgery. The surgeon was blinded to the result of the first of these examinations. Patients with clinical evidence of a leak underwent contrast radiology and upper gastrointestinal videoendoscopy. Results: Eight patients (11 per cent) developed a clinical leak from the oesophagojejunal anastomosis, seven before the first scheduled contrast swallow. Contrast radiology identified a leak in four of six patients. Endoscopy detected a leak in both patients with a false-negative swallow and in two patients who were not fit to undergo contrast radiology. Routine contrast radiology identified a subclinical leak in a further five patients (7 per cent), none of whom developed clinical signs. Four of seven in-hospital deaths were associated with an anastomotic leak. Conclusion: There is no role for routine contrast swallow after total gastrectomy with a stapled oesophagojejunal anastomosis, but patients with clinical suspicion of leakage should undergo urgent contrast radiology, plus endoscopy if the contrast examination is normal.


Publication metadata

Author(s): Lamb PJ, Griffin SM, Chandrashekar MV, Richardson DL, Karat D, Hayes N

Publication type: Article

Publication status: Published

Journal: British Journal of Surgery

Year: 2004

Volume: 91

Issue: 8

Pages: 1015-1019

ISSN (print): 0007-1323

ISSN (electronic): 1365-2168

Publisher: John Wiley & Sons Ltd

URL: http://dx.doi.org/10.1002/bjs.4638

DOI: 10.1002/bjs.4638


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