Clinical score predicting a successful endoscopic approach of esophageal anastomotic leaks: external validation. Issue 4 (April 2020)

• Record Type: Journal Article
• Authors: Azevedo, Richard; Coelho, Mariana; Gouveia, Catarina; Loureiro, Rui; Freire, Ricardo; Silva, Rui; Cravo, Marília; Pereira, António Dias; Ribeiro, Mário Dinis; de Ferro, Susana Mão
• Is Part Of: European journal of gastroenterology & hepatology. Volume 32:Issue 4(2020)
• Publication Date: 2020-04
• Subjects: anastomotic esophageal leak -- clinical prediction rule -- clinical success -- endoscopic stenting; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000001621
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Background: Recently, a clinical prediction rule has been proposed to predict the chance of successful endoscopic stenting in benign esophageal anastomotic leakage, perforation and fistula. We aimed to validate this score in a cohort of patients with anastomotic leaks managed with self-expanding metal esophageal stents, by assessing technical and clinical success rates and comparing the agreement between the predicted and the actual clinical success. Methods: A multicenter retrospective cohort study including patients submitted to endoscopic stenting due to anastomotic leak was conducted. Variables of the score (leak size, location and C-reactive protein) were collected and the chance of success (⩽50, 50–70 and ≥70%) and its accuracy was assessed. Results: Fifty-three patients, submitted to esophageal stenting after cancer ( n = 47) and bariatric surgery were included. Clinical success was achieved in 62% of patients. The area under the ROC curve to differentiate between successful and failed therapies showed a good discriminative power of the score (AUC 0.705; P < 0.01). For a predicted chance of success >50%, the positive predictive value was 72.5%; for a chance of success ⩽50%, the negative predictive value was 69.2%. Conclusions: The application of this predictive model in patients with anastomotic leaks proved to be valid in a different cohort from that in which it was derived. Its usefulness in clinical practice may be anticipated, favoring stenting in patients with a chance of success >50%. However, we must be cautious in patients with a lower probability of success and a case-by-case decision should be made.