Combined Computed Tomography and Amylase Criteria for Early and Precise Recognition of Anastomotic Leakage After Esophagectomy

Background: Anastomotic leak (AL) is a significant complication after esophagectomy, and current diagnostic methods are not standardized. We improved the chest computed tomography (CT) protocol and diagnostic criteria for detecting AL after esophagectomy. The objective of this study was to evaluate the diagnostic performance of the combined CT and amylase criteria for AL (cCTA-AL). Patients and Methods: We prospectively collected data from 184 patients who underwent contrast-enhanced chest CT and endoscopy simultaneously 3–7 days after esophagectomy between December 2021 and February 2023. To optimize the CT protocol for precise delineation of the esophagus, the contrast agent injection rate and scan time were modified. To improve the sensitivity, the chest CT data were combined with drain amylase levels. Two radiologists systematically evaluated CT features for AL, including wall discontinuity, adjacent mediastinal air, fluid collection, and decreased mucosal enhancement. We compared the cCTA-AL with endoscopic diagnosis. Results: A total of 21 of the 184 patients (11%) developed clinical leakage. The cCTA-AL exhibited a sensitivity, specificity, and accuracy of 57%, 98%, and 93%, respectively. Of the 21 patients with true clinical AL, 13 were identified with routine chest CT and/or endoscopy during the immediate postoperative period. Of these 13 patients, endoscopy revealed AL in 12 patients. In eight patients, AL was not detected on routine examination but AL developed after oral feeding. Conclusions: The cCTA-AL is a reliable method for diagnosing AL, comparable to endoscopy. The cCTA-AL could be considered depending on local resources and expertise.