Contrast Swallow in Post-Esophagectomy Care: Obsolete or Still a Valuable Tool?

Background Anastomotic leak (AL) remains an important postoperative complication that results in morbidity as well as mortality following esophagectomy for cancer. Contrast swallow is often use to rule out anastomotic leak as it is easy to perform. With easy access to computerized tomography imaging (CT) and endoscopy, the routine role of Contrast swallow needs to be assessed. The aim of this study is to evaluate the reliability of contrast swallow in detecting anastomotic leak. Methods This is a single institute retrospective study of prospectively maintained database of all patients who underwent esophagectomy for esophageal cancer between January 2016 and December 2024. Contrast swallow is done routinely on postoperative day 5 using water soluble Gastrograffin dye to detect AL, aspiration, any hold-up of contrast at pylorus and dilated stomach. The results of Contrast swallow are corelated with clinically detected and silent leaks. Radiological AL is then analysed with patient demographics, timing of study, location of anastomosis, history of neoadjuvant treatment and hospital stay. We subsequently calculated sensitivity, specificity, positive and negative predictive value of Contrast swallow. Results A total of 424 esophagectomies were performed between Jan 2016 and Dec 2024. Of 424 patients, contrast swallow detected frank leak in 11 patients (2.59%) and 2 patients had suspicious leak. Nine patients had clinical anastomotic leak which were not detected on contrast swallow (n = 9, 2.12%). Sensitivity—25% and Specificity—99%. Out of 424 patients, 23 patients had aspiration detected on X-ray (5.42%) and 7 patients had hold up of contrast at pylorus with delayed gastric emptying (1.65%). Thirty patients were found to have dilated gastric conduit (n = 30, 7.07%). Out of 424 patients. Conclusion Contrast swallow is not sensitive in detecting anastomotic leaks following esophagectomy. Alternative methods like CT contrast swallow may be more sensitive method to detect anastomotic leaks.