Drain fluid iodine as a biomarker of anastomotic leak after low anterior resection in patients undergoing Gastrografin rectal tube flushes and omission of a diverting ileostomy: The GUSH study

被引：0

作者：

Clark, David A. ^{[1
,2
,3
,4
]}

Dobeli, Karen ^{[5
]}

Allen, Darren ^{[6
]}

Mcwhinney, Brett ^{[6
]}

Lonne, Michael ^{[1
]}

GUSH Study Collaborator, Aleksandra

Edmundson, Aleksandra ^{[5
,6
]}

机构：

[1] Royal Brisbane & Womens Hosp, Dept Gen Surg, Brisbane, Qld, Australia

[2] Univ Queensland, Mayne Acad Surg, Brisbane, Australia

[3] St Vincents Private Hosp Northside, Dept Surg, Brisbane, Qld, Australia

[4] Univ Sydney, Fac Med & Hlth, Surg Outcomes Res Ctr SOuRCe, Sydney, NSW, Australia

[5] Royal Brisbane & Womens Hosp, Dept Radiol, Brisbane, Qld, Australia

[6] Royal Brisbane & Womens Hosp, Dept Chem Pathol, Pathol Queensland, Brisbane, Qld, Australia

来源：

COLORECTAL DISEASE | 2025年 / 27卷 / 02期

关键词：

anastomotic leak; biomarker; drain fluid; dual-energy CT; Gastrografin; inductively coupled mass spectroscopy; iodine; spectral CT; POSTOPERATIVE ILEUS; METAANALYSIS; MANAGEMENT;

D O I：

10.1111/codi.70031

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Aim Anastomotic leak (AL) is the anathema of colorectal surgery and its occurrence constitutes a serious risk to patients and places a substantial burden on the health system. The analysis of extravasated intraluminal substances in drain fluid has shown promise for the early detection of AL. The aim of this study is to assess the measurement of drain fluid iodine as a biomarker of AL. Method This prospective, observational, 2b exploration cohort study measured the iodine in drain fluid of patients undergoing a low colorectal anastomosis and without a diverting ileostomy (DI) when the rectal tube was flushed with Gastrografin (R). Iodine was measured by dual-energy computed tomography (DECT) and inductively coupled plasma mass spectroscopy (ICPMS). Results Sixty-six patients underwent a rectal resection and low colorectal anastomosis. Five patients experienced an AL. Four had grade C AL and returned to the operating theatre for peritoneal lavage and DI. The fifth was diagnosed at 30 days postoperatively and underwent image-guided drainage (grade B). The mean drain fluid iodine was significantly elevated in patients who experienced an AL compared with those who did not, as measured by DECT and ICPMS. The mean iodine value was 6.05 mg/mL vs. 0.088 mg/mL (p < 0.0001) for DECT and 41 437 mu mol/L vs. 3.81 mu mol/L (p < 0.0001) for ICPMS. Conclusion This study showed that drain iodine can be used as a sensitive indicator of early AL in patients undergoing a rectal resection with an extraperitoneal colorectal anastomosis and omission of a DI and when the rectal tube is flushed with Gastrografin following surgery.

引用

页数：10

共 26 条

[11]

Clark D.A., Yeoh E., Edmundson A., Harris C., Stevenson A., Steffens D., Et al., A development study of drain fluid gastrografin as a biomarker of anastomotic leak, Ann Coloproctol, 38, pp. 124-132, (2022)

[12]

Clark D.A., Yeoh E., Edmundson A., Pratap J., Snow T., Solomon M., Et al., Gastrografin can be detected in ex vivo biological specimens by dual-energy CT scanning, J Med Imaging Radiat Oncol, 64, pp. 634-640, (2020)

[13]

Xiao L., Zhang W.-B., Jiang P.-C., Bu X.-F., Yan Q., Li H., Et al., Can Transanal tube placement after anterior resection for rectal carcinoma reduce anastomotic leakage rate? A single-institution prospective randomized study, World J Surg, 35, pp. 1367-1377, (2011)

[14]

Shigeta K., Okabayashi K., Baba H., Hasegawa H., Tsuruta M., Yamafuji K., Et al., A meta-analysis of the use of a transanal drainage tube to prevent anastomotic leakage after anterior resection by double-stapling technique for rectal cancer, Surg Endosc, 30, pp. 543-550, (2016)

[15]

Dindo D., Demartines N., Clavien P.-A., Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey, Ann Surg, 240, pp. 205-213, (2004)

[16]

Rahbari N.N., Weitz J., Hohenberger W., Heald R.J., Moran B., Ulrich A., Et al., Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer, Surgery, 147, pp. 339-351, (2010)

[17]

Flores-Funes D., Campillo-Soto A., Pellicer-Franco E., Aguayo-Albasini J.L., The use of coffee, chewing-gum and gastrograffin in the management of postoperative ileus: a review of current evidence, Cir Esp, 94, pp. 495-501, (2016)

[18]

Habib K., Gupta A., White D., Mazari F.A.K., Wilson T.R., Utility of contrast enema to assess anastomotic integrity and the natural history of radiological leaks after low rectal surgery: systematic review and meta-analysis, Int J Colorectal Dis, 30, pp. 1007-1014, (2015)

[19]

Chintamani R.B., Randomized clinical study of Gastrografin administration in patients with adhesive small bowel obstruction (Br J Surg 2003

[20]

90: 542–546), Br J Surg, 90, (2003)

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