Para-Anastomotic Fluid Analysis After Esophagectomy: Preliminary Results From a Pilot Clinical Trial

Background Anastomotic leak is a serious complication following esophagectomy, with risk factors including poor conduit blood flow and cervical location of the anastomosis. Leaks occur in 10–25% of patients and lead to increased morbidity, additional healthcare utilization, and a mortality rate of 7–35%. Fluid acidity (pH) and electrical conductivity (EC) have been shown to be predictors of leak after colonic anastomoses. We hypothesize that pH and EC, from drain output, can enable early prediction of anastomotic leaks following esophagectomy. Methods A prospective pilot study of patients undergoing esophagectomy at a single academic institution was performed. A portable, non-invasive biosensor system was attached inline between a standard anastomotic drainage catheter and evacuator bulb. The sensor continuously monitored drainage fluid characteristics including pH and electrical conductivity (EC), viewed in real-time on a bedside monitor. Preliminary data are summarized with Lowess plots for visual comparison and summary statistics (average, standard deviation). Results Thirteen patients have been evaluated: 9 neck drains (from 7 transhiatal and 2 McKeown esophagectomies) and 7 chest drains (from 4 Ivor Lewis esophagectomies with 1–2 drains). One patient was diagnosed with a leak, and two patients were diagnosed with clinical neck infections without leak. Average pH from cervical (n = 6) or chest (n = 7) drains without leak/infection was 8.005+/−0.661 and 8.135+/−0.224, respectively (Fig. 1a). Average EC from cervical or chest drains was 11.441+/−1.178mS/cm and 12.691+/−0.538mS/cm, respectively (Fig. 1b). In one patient with leak, the average cervical drain pH was 7.639 (Fig. 1c) and average EC was 12.443 (Fig. 1d). Conclusion Preliminary data suggest that monitoring para-anastomotic electrical conductivity and pH merits continued investigation to predict post-esophagectomy anastomotic leaks, with pilot data showing similar trends (lower pH, higher EC) observed for intraperitoneal bowel anastomotic leaks.