Screening Diagnostics for Anastomotic Leakage after Ivor-Lewis Oesophagectomy : amylase level measurement in drain fluid compared with currently used parameters

Constantinides, A. (Alexander) (2015) Screening Diagnostics for Anastomotic Leakage after Ivor-Lewis Oesophagectomy : amylase level measurement in drain fluid compared with currently used parameters. thesis, Medicine.

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Abstract

Objectives: Anastomotic leakage (AL) after minimal invasive Ivor Lewis oesophagectomy (MI-ILE) is difficult to detect with standard clinical and biochemical parameters. Invasive and expensive diagnostic tests like CT and endoscopy are necessary to diagnose the potential life threatening AL. Amylase has shown to be able to predict AL. In this study we want to evaluate the place of amylase as a diagnostic marker for AL when compared to currently used parameters. Methods: In this multicentre study we collected data from 132 patients who underwent MI-ILE between November 2013 and February 2015. Amylase level measurements in drain fluid collected from the intrathoracic drains were daily performed. Currently used clinical (general malaise, respiratory rate, diuresis, blood pressure, temperature and heart rate) and biochemical parameters (leucocytes, C-Reactive Protein (CRP)) were collected. The outcome was an AL proven with CT and gastroscopy. Results: Of the currently used parameters, CRP shows the highest predictive values with a sensitivity and specificity of 94.1% and 32.3% respectively at the cut-off of 61mg/L. Positive predictive value was 39.4% and negative predictive value was 93.0%. Amylase with a cut-off point of 97 IU/L has a sensitivity of 66.7% and a specificity of 94.4%. Positive predictive value was 88.2% and negative predictive value was 92.2%. Conclusions: Currently used parameters have high sensitivity but very poor specificity for AL. Measuring amylase daily from drain fluid is more specific and has a high positive and negative predictive value. Therefore we deem daily amylase level measurement a valuable screening marker for AL.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty supervisor: and Kouwenhoven dr. E.A., Surgeon at ZGT Almelo. and Department of Surgery ZGT Almelo
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:46
Last Modified:	25 Jun 2020 10:46
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/707

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