Endoscopic grading system for predicting anastomotic complications after esophagectomy: a prospective cohort study. (Endoscopic grading system after esophagectomy)

Background: Postoperative complications related to gastric conduit reconstruction are still common issues after McKeown esophagectomy. A novel endoscopic grading system is desired to predict anastomotic complications after McKeown esophagectomy. Aims: and Methods The purpose of this study was prospectively to 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 the ischemic area was prospectively validated and classified into four categories according to the novel endoscopic mucosal ischemic grading system (EMIGS). Results: Fifteen patients (25.9%) developed anastomotic complications after esophagectomy. The negative predictive values for anastomotic complications, leakage, and strictures in EMIGS grades C or D were extremely high on POD 8 after esophagectomy (95.1%, 100%, and 95.1%, respectively). In the multivariate analysis, EMIGS grades C or D on POD 8 had a significant correlation with anastomotic complications after esophagectomy (odds ratio [OR]: 67.0; 95% confidence interval [CI]: 6.5-688.4; P < 0.01). EMIGS grades C or D on POD 8 after esophagectomy were associated with developing anastomotic leakage and strictures after esophagectomy in the univariate logistic regressions analysis (OR: 2.1 x 10 7 ; 95%CI:9.0 – infinity; P<0.01, OR:35.8; 95%CI:7.5 – 273.4; P<0.01, respectively). Conclusions: The application of endoscopic classification to mucosal ischemia after McKeown esophagectomy yielded suboptimal accuracy in predicting anastomotic complications. Trial registration Clinical Trial.gov Registry, ID: NCT02937389, Registration date: Oct 17, 2015