Flexible endoscopy is enough diagnostic prior to loop ileostomy reversal

Area of Science:

• Colorectal surgery
• Diagnostic imaging
• Gastroenterology

Background:

• Low anterior resection (LAR) with loop ileostomy is common for rectal cancer.
• Ileostomy reversal follows LAR, but requires assessment for anastomotic leakage (AL).
• The role of routine pre-reversal diagnostic testing (contrast enema [CE] and flexible endoscopy [FE]) is debated.

Purpose of the Study:

• To evaluate if CE and FE should be routinely performed before ileostomy reversal after LAR.
• To assess the impact of previous anastomotic leakage (AL) on the diagnostic test accuracy (DTA) of CE and FE.

Main Methods:

• Retrospective analysis of prospectively collected data from two tertiary care centers.
• Included consecutive rectal cancer patients undergoing LAR with loop ileostomy.
• Assessed DTA of CE and FE for asymptomatic AL in patients with (group 1) and without (group 0) prior clinically relevant AL.

Main Results:

• 293 patients analyzed (86 in group 1, 207 in group 0).
• FE sensitivity: 76%, CE sensitivity: 60% for asymptomatic AL (specificity 100% for both).
• FE DTA was equal or superior to CE; asymptomatic AL prevalence was 25.6% in group 1 vs. 1.4% in group 0.

Conclusions:

• Flexible endoscopy is the superior diagnostic test for asymptomatic anastomotic leaks before ileostomy reversal.
• Contrast enema provides no additional information.
• Routine testing may be questionable in patients without prior complications, as many require testing to detect one leak.