The clinical relevance of postoperative routine contrast swallow following esophagectomy

Background: Limited evidence exists regarding the role of the routine contrast swallow in determining the safety of initiating oral intake following esophagectomy. Therefore, this study evaluated its clinical relevance in decision-making regarding oral intake. Methods: A descriptive, observational, single-center study included esophageal cancer patients who underwent esophagectomy with gastric conduit reconstruction between March 2019 and March 2021. Patients were kept nil by mouth until postoperative day (POD) 3 and began oral intake from POD 4 if the contrast swallow was normal. The primary outcome was routine use (POD 2–6) of the contrast swallow and its impact on oral intake decisions. Predictors of an abnormal contrast swallow were explored using logistic regression. Results: A contrast swallow was routinely performed in 80 of 110 patients (73%), of which 48 (44%) had a normal contrast swallow, while 32 (29%) had an abnormal contrast swallow. Ultimately, in 28 patients (25%), findings of the contrast swallow led to a decision to delay oral intake. All abnormal contrast swallows (n=32) involved aspiration (n=30, 94%) or laryngeal penetration (n=2, 6%). Aspiration occurred alongside delayed gastric conduit emptying in 2 cases, and anastomotic leakage was suspected in 2 others but not confirmed on computed tomography (CT) scan. No statistically independent predictors of an abnormal contrast swallow were identified in multivariable analysis. Conclusions: Routine contrast swallow following esophagectomy led to withholding oral intake in 25% of cases. Future research should explore a more selective approach in specific patient categories.