470. DO RADIOLOGISTS ALWAYS USE ORAL CONTRAST DURING CT SCANNING FOR POST-ESOPHAGECTOMY ANASTOMOTIC LEAK: SURVEY OF PROTOCOLS IN THE UK
Rohit Panackal, Alexis Sudlow, Suheelan Kulasegaran, Bhaskar Kumar- Gastroenterology
- General Medicine
Abstract
Background
Anastomotic leak (AL) is a life-threatening complication following esophagectomy. Early and accurate diagnosis is key. Although computerized tomography (CT) scan is a widely employed diagnostic modality, there is no consensus on whether oral contrast should be used in addition to IV contrast. We sought to survey protocols regarding the use of oral contrast amongst specialist radiologists when using CT scan to diagnose AL.
Methods
An online questionnaire was sent to 27 consultant gastrointestinal (GI) radiologists with a subspecialist esophageal interest from 11 tertiary centres. Participants were primarily asked for their preferred imaging modality to diagnose AL, choice of contrast if a CT scan was used (assuming no contraindications for IV contrast) and an explanation for their preferred choice of investigation.
Results
The response rate was 96.3% (n = 26). Most participants (16 [61.5%]) used CT scan as first choice modality, while six (23.1%) used fluoroscopy and two (15.3%) used CT scan and fluoroscopy. With CT scan, half the participants preferred using both oral and IV contrast to IV contrast alone. No participants chose oral contrast alone. Some participants who used oral contrast felt it helped differentiate between normal post-surgical changes and true leaks. Limitations of using oral contrast included concerns of missed leaks involving the anterior aspect of the esophagus and lowered enhancement of the esophageal mucosa.
Conclusion
The majority of radiologists favor using oral contrast in addition to IV contrast for CT scan for suspected AL. In spite of this, practice is variable even amongst radiologists from the same unit. The lack of consensus emphasizes the need for further research to establish best practice and formulation of guidelines.