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Background <p>Anastomotic leak (AL) is a severe complication after minimally invasive esophagectomy (MIE). While endoscopy within 72&#xa0;h is safe, the optimal timing is undefined. This study investigates the safety and efficacy of ultra-early postoperative endoscopy (UPE, within 24&#xa0;h) for evaluating AL after MIE.</p> Methods <p>Patients undergoing MIE (March 2015–August 2025) were grouped by their first endoscopic exam: UPE (≤ 24&#xa0;h) or early postoperative endoscopy (EPE, 24–72&#xa0;h). Propensity score matching (PSM) balanced baseline characteristics. Outcomes included complications, hospital stay, and mortality. Logistic regression identified AL risk factors.</p> Results <p>A total of 941 patients were enrolled, including 284 in the UPE and 657 in the EPE. 274 matched pairs were generated after PSM, and the baseline characteristics were balanced and comparable. Before and after PSM, the UPE group did not increase the risk of postoperative adverse events, nor did it increase in-hospital mortality (all <i>P</i> &gt; 0.05). After PSM, the UPE group had significantly lower incidences of AL (11.31 vs. 20.07%, <i>P</i> = 0.007) and hypoproteinemia (9.49 vs. 21.90%, <i>P</i> &lt; 0.001), and a shorter median hospital stay (<i>P</i> = 0.01) compared to the EPE group. Multivariate analysis confirmed UPE as an independent protective factor against AL (OR = 0.476, 95% CI: 0.315–0.718, <i>P</i> &lt; 0.001).</p> Conclusion <p>UPE is a safe and effective strategy following MIE. By facilitating early risk identification and the safe initiation of enteral nutrition, UPE is associated with significantly lower rates of AL and hypoproteinemia, and a shorter hospital stay.</p> Graphical abstract <p></p>

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Ultra-early postoperative endoscopy reduces anastomotic leak after minimally invasive esophagectomy: a propensity score-matched study

  • 期刊论文

  • 发表日期：

    2026年4月30日

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  • Yang Shen,
  • Xuan-Feng Ren,
  • He Xu,
  • Fan Gao,
  • Jing-Wei Sun,
  • Yu-Quan Bai

摘要

Background

Anastomotic leak (AL) is a severe complication after minimally invasive esophagectomy (MIE). While endoscopy within 72 h is safe, the optimal timing is undefined. This study investigates the safety and efficacy of ultra-early postoperative endoscopy (UPE, within 24 h) for evaluating AL after MIE.

Methods

Patients undergoing MIE (March 2015–August 2025) were grouped by their first endoscopic exam: UPE (≤ 24 h) or early postoperative endoscopy (EPE, 24–72 h). Propensity score matching (PSM) balanced baseline characteristics. Outcomes included complications, hospital stay, and mortality. Logistic regression identified AL risk factors.

Results

A total of 941 patients were enrolled, including 284 in the UPE and 657 in the EPE. 274 matched pairs were generated after PSM, and the baseline characteristics were balanced and comparable. Before and after PSM, the UPE group did not increase the risk of postoperative adverse events, nor did it increase in-hospital mortality (all P > 0.05). After PSM, the UPE group had significantly lower incidences of AL (11.31 vs. 20.07%, P = 0.007) and hypoproteinemia (9.49 vs. 21.90%, P < 0.001), and a shorter median hospital stay (P = 0.01) compared to the EPE group. Multivariate analysis confirmed UPE as an independent protective factor against AL (OR = 0.476, 95% CI: 0.315–0.718, P < 0.001).

Conclusion

UPE is a safe and effective strategy following MIE. By facilitating early risk identification and the safe initiation of enteral nutrition, UPE is associated with significantly lower rates of AL and hypoproteinemia, and a shorter hospital stay.

Graphical abstract