517. INTERNATIONAL CONSENSUS AND CLINICAL CARE ALGORITHM FOR THE DIAGNOSIS AND TREATMENT OF ANASTOMOTIC LEAK AFTER ESOPHAGECTOMY

Abstract Background Anastomotic leak (AL) is a common and severe complication after esophagectomy. Guidelines for the management of AL are lacking due to limited evidence, in which case consensus can provide a sound base for guiding clinical practice. This study aimed to develop a consensus-based guideline and clinical algorithm on the diagnosis and treatment of AL after esophagectomy. Methods A three-stage modified Delphi study was performed. Stage 1 comprised a scoping systematic review to find available evidence and formulate statements. Methodological quality was assessed using the Newcastle-Ottawa scale. Stage 2 comprised a two-round Delphi survey, globally distributed to surgeons and gastro-enterologists experienced in diagnosing and treating AL. During stage 3, clinical recommendations were formulated by an international expert panel, based on the Delphi consensus and a strength was assigned following GRADE principals. A clinical care algorithm was developed based on these recommendations. This study was performed in collaboration with the ISDE Guidelines Committee. Results A total of 5.843 articles were screened, and 118 included to formulate Delphi statements. The Delphi survey was completed by 106 participants in the first round and 136 in the second. Consensus was achieved on 13 statements on diagnosis and 21 statements on treatment of AL. During the guideline development stage, 12 diagnostic recommendations were formulated covering screening, clinical signs, biochemical tests, and imaging for the diagnosis of AL. 15 recommendations were formulated regarding treatment strategies of AL and indications and techniques for supportive care, drainage and defect closure. A clinical care algorithm on diagnosis and treatment of AL was designed. Conclusion This study developed clinical recommendations based on consensus and available evidence, and designed a clinical care algorithm for the diagnosis and treatment of AL after esophagectomy. The developed recommendations and clinical care algorithm, may provide clinical support and aid standardized decision-making in clinical practice and potentially improve patient outcomes.