P1.219. Functional Radiology Assessment of Gastric Conduit Emptying After Esophagectomy for Cancer With Gastric Conduit Reconstruction; a Pilot Study

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Symptoms of delayed gastric conduit emptying are common in patients with a gastric conduit reconstruction after esophagectomy, but standardized radiologic evaluation is missing. We aim to describe the pattern of gastric conduit emptying by functional upper gastrointestinal contrast series, and to determine whether Barium or water soluble contrast is more suitable. The study was approved by the Karolinska University Hospital Radiation Protection Committee and Regional Ethics Board of Stockholm. 30 patients were recruited at least 3 months after esophagectomy and filled in the DGCE symptom grading questionnaire developed in an international consensus process, and baseline data was registered. During a second appointment, radiology according to two phases of the radiology study protocol was performed. In the first phase, 2D frontal images were taken before, 2, 5, 10 and 20 minutes after swallowing 100 ml of water-soluble contrast fluid and at 30 minutes a low-radiation-dose computerized tomography was performed to better quantify possibly remaining contrast fluid. The second phase was performed in same manner using 100 ml of barium contrast. Two radiologists analyzed the images according to a pre-defined protocol, evaluating pillar length and area development as indicators of conduit emptying. Other factors evaluated were difficulty of evaluation, conduit form and risks Thirty cases accepted to participate in the study, mean age was 68 years (range 52-83), 9 (30%) were female, mean ASA-score was 2,4 (range 2-3) and mean Charlson Comorbidity Index was 3 (range 1-8). All underwent water soluble contrast evaluation, but 5 were not evaluated with barium, due to: 1) large residual food content, 2) anastomotic leakage, 3) pulmonary embolism, 4) aspiration of water-soluble contrast and 5) consent withdrawal. In all cases of evaluation by Barium contrast it was possible to measure contrast pillar and contrast area, but in 5 cases of evaluation by water soluble contrast, poorly definable borders made measurement impossible. Subjectively the radiologists considered barium more trustworthy in 18 cases and easier to measure in 17 cases of the 25 cases available for comparison and the rest of the cases were considered equivalent. Area was considered less demanding than pillar length. Further results will be presented Due to lack of standardization of functional radiology for individuals with a gastric conduit, methods of objective evaluation are lacking. This is the first study to attempt to describe the emptying function of the gastric conduit in 30 unselected individuals by contrast follow. Preliminary results indicate that area measurement and Barium contrast may be preferrable, but safety measures need to be taken, and the results need to be studied further in a multy-center study.