Simple endoscopic estimation to predict anastomotic complications after bronchoplastic procedures

Abstract OBJECTIVES Endoscopic evaluation of anastomosis is effective for the early detection of anastomotic complications after a bronchoplastic procedure. Herein, we aimed to clarify important findings for predicting anastomotic complications. METHODS This single-centre retrospective study included patients who underwent bronchoplastic surgery between April 2013 and September 2023. Only cases in which bronchoscopy was performed both 1 and 2 weeks after surgery were included. Endoscopic findings (classification by Ludwig and Stoelben, mucosa colour, oedema, slough area and colour, and depression) were reviewed for all cases. The accuracy of these findings for predicting anastomotic complications was evaluated. RESULTS Of the 190 patients included in this study, 14 (7.4%) experienced anastomotic abnormalities, 11 had fistulas (5.8%), and 7 had stenosis (3.7%). The onsets of fistula and stenosis were 20–28 and 20–44 days after surgery, respectively. In 102 patients (53.7%), the slough worsened from the first to the second week post-surgery. Therefore, it was easier to evaluate slough 2 weeks post-surgery rather than 1-week post-surgery. The positive/negative predicted values of anastomotic complications in endoscopic findings 2 weeks post-surgery were circular slough, 34.2%/99.3%; slough with dark colour, 39.3%/98.1%; and depression, 54.2%/99.4%. The incidence of anastomotic abnormalities was 0% in cases without the three findings, 10% in cases with at least one finding, and 67% in cases with all three findings. CONCLUSIONS The endoscopic findings of slough on the anastomosis 2 weeks after bronchoplasty can be easily evaluated and accurately predict complications. Three important endoscopic findings were circular slough, dark colour, and depression.