Endoscopic mucosal ischemic index for predicting anastomotic complications after esophagectomy: a prospective cohort study.

Tytuł:: Endoscopic mucosal ischemic index for predicting anastomotic complications after esophagectomy: a prospective cohort study.
Autorzy:: Kobayashi S; Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528102, Japan. .
Kanetaka K; Department of Tissue Engineering and Regenerative Therapeutics in Gastrointestinal Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, Japan.
Yoneda A; Department of Surgery, National Hospital Organization Nagasaki Medical Center, Kubara 2-1001-1, Ohmura, Nagasaki, Japan.
Yamaguchi N; Department of Endoscopy, Nagasaki University Hospital, Sakamoto 1-7-1, Nagasaki, Japan.
Kobayashi K; Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528102, Japan.
Nagata Y; Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528102, Japan.; Center for Comprehensive Community Care Education, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, Japan.
Maruya Y; Department of Tissue Engineering and Regenerative Therapeutics in Gastrointestinal Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, Japan.
Yamaguchi S; Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528102, Japan.
Hidaka M; Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528102, Japan.
Eguchi S; Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528102, Japan.
Źródło:: Langenbeck's archives of surgery [Langenbecks Arch Surg] 2023 Jan 17; Vol. 408 (1), pp. 37. Date of Electronic Publication: 2023 Jan 17.
Typ publikacji:: Clinical Trial; Journal Article
Język:: English
Imprint Name(s):: Original Publication: Berlin : Springer-Verlag, c1998-
MeSH Terms:: Esophageal Neoplasms*/surgery
Esophagectomy*/adverse effects
Humans ; Anastomosis, Surgical/adverse effects ; Anastomotic Leak/diagnosis ; Anastomotic Leak/epidemiology ; Anastomotic Leak/etiology ; Constriction, Pathologic/surgery ; Ischemia/etiology ; Ischemia/surgery ; Mucous Membrane/pathology ; Mucous Membrane/surgery ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Prospective Studies ; Retrospective Studies
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Contributed Indexing:: Keywords: Endoscopy; Esophageal cancer; Leakage; McKeown esophagectomy; Stricture
Molecular Sequence:: ClinicalTrials.gov NCT02937389
Entry Date(s):: Date Created: 20230117 Date Completed: 20230120 Latest Revision: 20240118
Update Code:: 20240118
DOI:: 10.1007/s00423-023-02783-x
PMID:: 36648542
: Czasopismo naukowe

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Background: Postoperative complications related to gastric conduit reconstruction are still common issues after McKeown esophagectomy. A novel endoscopic mucosal ischemic index is desired to predict anastomotic complications after McKeown esophagectomy.
Aims and Methods: The purpose of this study was to prospectively evaluate the safety and efficacy of endoscopic examinations of the anastomotic region in the acute period after esophagectomy. Endoscopic examinations were performed on postoperative days (PODs) 1 and 8. The severity of ischemia was prospectively validated according to the endoscopic mucosal ischemic index (EMII).
Results: A total of 58 patients were included after evaluating the safety and feasibility of the endoscopic examination on POD 1 in 10 patients. Anastomotic leakage occurred in 6 patients. Stricture occurred in 13 patients. A greater than 67% circumference and lesion length greater than 20 mm of anastomotic ischemic area (AIA) on POD 1 were associated with developing anastomotic leakage after esophagectomy (OR: 14.5; 95% CI: 1.8-306.5; P = 0.03, OR: 19.4; 95% CI: 1.7-536.8; P = 0.03). More than 67% circumferential ischemic mucosa and ischemic mucosal lengths greater than 20 mm of AIA on POD 1 were associated with developing anastomotic strictures after esophagectomy (OR: 6.4; 95% CI: 1.4-31.7; P = 0.02, OR: 5.9; 95% CI: 1.2-33.1; P = 0.03). Patients with either more than 67% circumferential ischemic mucosa or ischemic mucosal lengths greater than 20 mm of AIA on POD 1 were defined as EMII-positive patients. The sensitivity, specificity, and positive and negative predictive values of EMII positivity on POD 1 for leakage were 100%, 78.8%, 35.3%, and 100%, respectively. The sensitivity, specificity, and positive and negative predictive values of the EMII positivity on POD 1 for strictures were 69.2%, 82.2%, 52.9%, and 90.2%, respectively.
Conclusions: The application of an endoscopic classification system to mucosal ischemia after McKeown esophagectomy is both appropriate and satisfactory in predicting anastomotic complications.
Trial Registration: Clinical Trial.gov Registry, ID: NCT02937389, Registration date: Oct 17, 2015.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Erratum in: Langenbecks Arch Surg. 2023 Feb 16;408(1):92. (PMID: 36792843)

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