The role of upper gastrointestinal swallow study in patients undergoing proximal or total gastrectomy

Background: One of the ominous complications following proximal gastrectomy or total gastrectomy is a leak from the esophagogastric or esophagojejunal anastomosis. An upper gastrointestinal swallow study is traditionally performed to confirm the anastomotic patency and lack of any leak before oral feeding can be initiated. Objectives: To challenge the routine use of UGISs following proximal or total gastrectomy in order to check the integrity of the gastroesophageal or jejunoesophageal anastomosis. Methods: The charts of 99 patients who underwent PG or TG for malignant pathology were retrospectively reviewed. UGISs were performed on day 6 following surgery using a water-soluble material. Results: The UGISs were normal in 95 patients, with none displaying any complication related to the gastroesophageal or jejunoesophageal anastomosis. All four patients who experienced a leak from the anastomosis had an early stormy postoperative course. Conclusions: Routine use of an UGIS to detect a leak following PG or TG is not justified. UGIS should be performed whenever signs of abdominal sepsis develop following this type or surgery.