Introduction
Fluoroscopic oral contrast study is used to guide early NGT removal and diet commencement post-operatively. Timely studies are reliant on radiology staff and patient ability to stand for the test. We assess compliance, barriers to timely swallow study and implications for NGT removal and discharge.
Methods
Patients undergoing oesophagectomy and gastrectomy at our institution between April 2023 and May 2024 were followed under the ERAS audit. Contrast swallow study was booked for the first opportunity from POD 3 with the aim to perform by POD 5.
Results
125 patients were enrolled. 91 patients underwent oesophagectomy (87% 2-stage, 13% 3-stage) with various approaches (53% minimally invasive, 44% open, 3% hybrid). Total gastrectomy was performed for 34 patients (76% open, 12% thoracoabdominal, 12% laparoscopic).
Contrast swallow occurred on the first possible fluoroscopy day (M/W/F) from POD 3 onwards in 62% of cases. Tuesday and Friday cases typically undergo contrast study on POD 3, while Monday and Thursday patients wait till POD 4.
Contrast study occurred by POD 5 in 72% of cases. This group had earlier NGT removal and diet commencement (median POD 4 vs POD 6.5, p<0.0001) and shorter median hospital stay (11 vs 16 days, p=0.03).
Fluoroscopic diagnoses of delayed emptying were low (2%).
Barriers to timely studies included non-availability of fluoroscopy staff (14%), concern regarding aspiration (4%) and patients being unstable or unable to stand for the test (10%).
Conclusion
Timely contrast study is achievable and does facilitate earlier NGT removal and discharge. However, logistic and patient factors can be further optimized.