抗反流手术后早期造影食管造影：前肠专科医生的使用、感知价值及对出院的影响

文献信息

中文摘要

背景： 抗反流和前肠手术后早期术后食管造影检查的使用情况不一，常规检查的价值仍不确定。本研究调查了前肠外科医生关于早期造影成像的实践模式、适应证、感知阳性率和出院影响。
方法： 通过机构邮件列表、美国胃肠与内镜外科医师学会前肠与柔性内镜委员会以及美国前肠学会DocMatter社区分发了一份匿名网络问卷。受访者报告了实践特征、特定手术中早期（<72小时）造影成像的使用、选择性成像的适应证、感知的管理影响以及出院后果。采用描述性统计对回答进行总结。
结果： 66名外科医生回应，97%从事前肠手术。大多数在学术或混合机构执业（77%），并接受过微创手术（59%）和/或前肠/晚期胃肠手术（63%）的专科培训。79%总是或大多数时候使用术中内镜。在初次手术后，常规早期造影成像不常见，包括滑动型食管裂孔疝修补术（22%）、食管旁疝修补术（28%）、完全胃底折叠术（23%）、部分胃底折叠术（23%）、磁性括约肌增强术（26%）、连续经口无切口胃底折叠术（30%）和Roux-en-Y胃旁路术（30%）。再次抗反流手术促使更频繁的检查，44%报告常规成像。选择性成像的主要触发因素为术中担忧或损伤（88%）、早期经口不耐受或吞咽困难（69%）以及非典型解剖（46%）。大多数受访者（81%）估计只有0-5%的检查改变了管理。当管理改变时，饮食调整（41%）和返回手术室（30%）最常见。30%报告在超过10%的患者中出院延迟，通常延迟6-24小时。
结论： 在前肠专科医生中，抗反流手术后常规早期造影成像不常见，通常保留用于再次手术或特定临床问题。受访者认为可操作阳性率低，并在部分患者中造成出院延迟，支持在简单病例中选择性使用。

英文摘要

BACKGROUND: Early postoperative esophageal contrast studies after anti-reflux and foregut surgery are used variably, and the value of routine testing remains uncertain. This study surveyed foregut surgeons regarding practice patterns, indications, perceived yield, and discharge impact of early contrast imaging.
METHODS: An anonymous web-based questionnaire was distributed through an institutional listserv, the Society of American Gastrointestinal and Endoscopic Surgeons Foregut and Flexible Endoscopy Committees, and the American Foregut Society DocMatter community. Respondents reported practice characteristics, procedure-specific use of early (< 72 h) contrast imaging, indications for selective imaging, perceived management impact, and discharge consequences. Responses were summarized with descriptive statistics.
RESULTS: Sixty-six surgeons responded, 97% performed foregut surgery. Most practiced in academic or hybrid settings (77%) and were fellowship trained in minimally invasive surgery (59%) and/or foregut/advanced gastrointestinal surgery (63%). Intraoperative endoscopy was used always or most of the time by 79%. Routine early contrast imaging was uncommon after primary procedures, including sliding hiatal hernia repair (22%), paraesophageal hernia repair (28%), complete fundoplication (23%), partial fundoplication (23%), magnetic sphincter augmentation (26%), consecutive transoral incisionless fundoplication (30%), and Roux-en-Y gastric bypass (30%). Redo anti-reflux surgery prompted more frequent testing, with 44% reporting routine imaging. Leading triggers for selective imaging were intraoperative concern or injury (88%), early oral intolerance or dysphagia (69%), and atypical anatomy (46%). Most respondents (81%) estimated that only 0-5% of studies changed management. When management changed, diet modification (41%) and return to the operating room (30%) were most common. Thirty percent reported discharge delays in > = 10% of patients, usually by 6-24 h.
CONCLUSIONS: Routine early contrast imaging after anti-reflux surgery is uncommon among foregut specialists and is usually reserved for redo operations or specific clinical concerns. Respondents perceived low actionable yield and discharge delays in a subset of patients, supporting selective use in straightforward cases.