ArticleSurgical endoscopy2018
An endoscopic mucosal grading system is predictive of leak in stapled rectal anastomoses.
Article in Surgical endoscopy, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 28 citations in OpenAlex.
- Safety and Feasibility Colorectal Anastomosis Protocol Implementation: Results from the CASPI Single-Arm Pilot Study.Cancers · 2026Article
- Techniques in coloproctology - controversies in coloproctology resection: rectopexy is an underutilised procedure in the management of both symptomatic high-grade internal and external rectal prolapse.Techniques in coloproctology · 2025Article
- Mitigating 'inevitable' anastomotic leaks in left-sided colorectal surgery: a combined strategy using indocyanine green fluorescence, intraoperative colonscopy and patient risk profiling.Updates in surgery · 2025Article
- Bedside endoscopic inspection of colorectal anastomoses in the early postoperative period: a 2-center prospective feasibility study.Annals of coloproctology · 2025Article
- Perioperative assessment of colorectal anastomoses with flexible endoscopy.Updates in surgery · 2025Article
- Validation of an endoscopic anastomotic grading score as an intraoperative method for assessing stapled rectal anastomoses.Techniques in coloproctology · 2023Article
- Bacteriological concentration of peritoneal drainage fluid could make an early diagnosis of anastomotic leakage following rectal resection.Scientific reports · 2021Article
- Intraoperative endoscopy with immediate suture reinforcement of the defect in colorectal anastomosis: a pilot study.Updates in surgery · 2020Article
- Simultaneous transabdominal and transanal indocyanine green fluorescence imaging for low colorectal anastomosis.Techniques in coloproctology · 2019Article
- Operative Management of Anastomotic Leaks after Colorectal Surgery.Clinics in colon and rectal surgery · 2019Review
- Technique of air-leak testing of ileocolic anastomosis.Techniques in coloproctology · 2018Article
- Risks of anastomotic leakage in patients with colorectal cancer after operation and how to effectively avoid it.Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciencesArticle
Corrections and comments
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundAnastomotic leak is a devastating postoperative complication following rectal anastomoses associated with significant clinical and oncological implications. As a result, there is a need for novel intraoperative methods that will help predict anastomotic leak.
methodsFrom 2011 to 2014, patient undergoing rectal anastomoses by colorectal surgeons at our institution underwent prospective application of intraoperative flexible endoscopy with mucosal grading. Retrospective review of patient medical records was performed. After creation of the colorectal anastomosis, application of a three-tier endoscopic mucosal grading system occurred. Grade 1 was defined as circumferentially normal appearing peri-anastomotic mucosa. Grade 2 was defined as ischemia or congestion involving <30% of either the colon or rectal mucosa. Grade 3 was defined as ischemia or congestion involving >30% of the colon or rectal mucosa or ischemia/congestion involving both sides of the staple line.
resultsFrom 2011 to 2014, a total of 106 patients were reviewed. Grade 1 anastomoses were created in 92 (86.7%) patients and Grade 2 anastomoses were created in 10 (9.4%) patients. All 4 (3.8%) Grade 3 patients underwent immediate intraoperative anastomosis takedown and re-creation, with subsequent re-classification as Grade 1. Demographic and comorbidity data were similar between Grade 1 and Grade 2 patients. Anastomotic leak rate for the entire cohort was 12.2%. Grade 1 patients demonstrated a leak rate of 9.4% (9/96) and Grade 2 patients demonstrated a leak rate of 40% (4/10). Multivariate logistic regression associated Grade 2 classification with an increased risk of anastomotic leak (OR 4.09, 95% CI 1.21-13.63, P = 0.023).
conclusionEndoscopic mucosal grading is a feasible intraoperative technique that has a role following creation of a rectal anastomosis. Identification of a Grade 2 or Grade 3 anastomosis should provoke strong consideration for immediate intraoperative revision.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.