Blood Flow Assessment of Gastric Tube with Indocyanine Green Fluorescence Angiography and Postoperative Endoscopy During Esophagectomy: Indocyanine Green Enhancement Time Indicated Congestion

Overview

Journal BMC Gastroenterol

Publisher Biomed Central

Specialty Gastroenterology

Date 2024 Sep 17

PMID 39289637

Authors

Jun Sakuma

Akihiro Hoshino

Hisashi Fujiwara

Taichi Ogou

Kenro Kawada

Keisuke Okuno

Toshiro Tanioka

Shigeo Haruki

Masanori Tokunaga

Yusuke Kinugasa

Affiliations

Soon will be listed here.

Abstract

Background: During esophagectomy, evaluation of blood supply to the gastric tube is critically important to estimate and avoid anastomotic complications. This retrospective study investigated the relationship between indocyanine green (ICG) fluorescence angiography during esophagectomy and postoperative endoscopy findings, especially mucosal color change.

Methods: This study retrospectively collected data from 86 patients who underwent subtotal esophagectomy and reconstruction using a gastric tube for esophageal cancer at the Tokyo Medical and Dental University between 2017 and 2020. The flow speed of ICG fluorescence in the gastric tube was evaluated during the operation. Additionally, the main root of ICG enhancement and pattern of ICG distribution in the gastric tube were evaluated. On postoperative day 1 (POD1), the change in the mucosal color to white, thought to reflect ischemia, or black, thought to reflect congestion of the proximal gastric tube, was evaluated. The correlations between these factors, clinical parameters, and surgical outcomes were evaluated. Univariate and multivariate analyses used logistic regression to identify the risk factors affecting mucosal color change.

Results: Multivariate analyses revealed that the only independent significant predictor of mucosal congestion on POD1 was the ICG enhancement time of the right gastric tube tip (odds ratio, 14.49; 95% confidential interval, 2.41-87.24; P = 0.004).

Conclusions: This study indicated that the ICG enhancement time is related to venous malperfusion and congestion rather than arterial malperfusion and ischemia.

References

Shimada Y, Okumura T, Nagata T, Sawada S, Matsui K, Hori R . Usefulness of blood supply visualization by indocyanine green fluorescence for reconstruction during esophagectomy. Esophagus. 2012; 8(4):259-266. PMC: 3339581. DOI: 10.1007/s10388-011-0291-7. View

Luo R, Zhu Z, He Z, Xu Y, Wang Y, Chen P . Efficacy of Indocyanine Green Fluorescence Angiography in Preventing Anastomotic Leakage After McKeown Minimally Invasive Esophagectomy. Front Oncol. 2021; 10:619822. PMC: 7821423. DOI: 10.3389/fonc.2020.619822. View

Kumagai Y, Hatano S, Sobajima J, Ishiguro T, Fukuchi M, Ishibashi K . Indocyanine green fluorescence angiography of the reconstructed gastric tube during esophagectomy: efficacy of the 90-second rule. Dis Esophagus. 2018; 31(12). DOI: 10.1093/dote/doy052. View

Zehetner J, DeMeester S, Alicuben E, Oh D, Lipham J, Hagen J . Intraoperative Assessment of Perfusion of the Gastric Graft and Correlation With Anastomotic Leaks After Esophagectomy. Ann Surg. 2014; 262(1):74-8. PMC: 4463028. DOI: 10.1097/SLA.0000000000000811. View

Fujiwara H, Nakajima Y, Kawada K, Tokairin Y, Miyawaki Y, Okada T . Endoscopic assessment 1 day after esophagectomy for predicting cervical esophagogastric anastomosis-relating complications. Surg Endosc. 2015; 30(4):1564-71. DOI: 10.1007/s00464-015-4379-3. View

Ishiguro T, Kumagai Y, Ono T, Imaizumi H, Honjo H, Suzuki O . Usefulness of indocyanine green angiography for evaluation of blood supply in a reconstructed gastric tube during esophagectomy. Int Surg. 2013; 97(4):340-4. PMC: 3727260. DOI: 10.9738/CC159.1. View

Yamaguchi K, Kumagai Y, Saito K, Hoshino A, Tokairin Y, Kawada K . The evaluation of the gastric tube blood flow by indocyanine green fluorescence angiography during esophagectomy: a multicenter prospective study. Gen Thorac Cardiovasc Surg. 2021; 69(7):1118-1124. DOI: 10.1007/s11748-021-01640-2. View

Fujioka M, Hayashida K, Fukui K, Ishiyama S, Saijo H, Taniguchi K . Venous superdrained gastric tube pull-up procedure for hypopharyngeal and cervical esophageal reconstruction reduces postoperative anastomotic leakage and stricture. Dis Esophagus. 2017; 30(8):1-6. DOI: 10.1093/dote/dox024. View

Ito S, Fujiwara N, Kume Y, Tsukamoto F, Saito K, Hoshino A . Mucosal Congestion on the First Day Following Endoscopy Predicts Anastomotic Stricture After Esophagectomy. World J Surg. 2022; 46(3):631-638. DOI: 10.1007/s00268-021-06397-6. View

10.

Thammineedi S, Patnaik S, Saksena A, Ramalingam P, Nusrath S . The Utility of Indocyanine Green Angiography in the Assessment of Perfusion of Gastric Conduit and Proximal Esophageal Stump Against Visual Assessment in Patients Undergoing Esophagectomy: a Prospective Study. Indian J Surg Oncol. 2020; 11(4):684-691. PMC: 7714815. DOI: 10.1007/s13193-020-01085-8. View

11.

Rino Y, Yukawa N, Sato T, Yamamoto N, Tamagawa H, Hasegawa S . Visualization of blood supply route to the reconstructed stomach by indocyanine green fluorescence imaging during esophagectomy. BMC Med Imaging. 2014; 14:18. PMC: 4041049. DOI: 10.1186/1471-2342-14-18. View

12.

Kamiya K, Unno N, Miyazaki S, Sano M, Kikuchi H, Hiramatsu Y . Quantitative assessment of the free jejunal graft perfusion. J Surg Res. 2014; 194(2):394-399. DOI: 10.1016/j.jss.2014.10.049. View

13.

Takeuchi M, Onoda M, Yoshida K, Iwamura M, Furutani A, Kawano K . Effect of Venous Superdrainage on Colon Interposition for Esophageal Reconstruction. J UOEH. 2020; 42(4):331-334. DOI: 10.7888/juoeh.42.331. View

14.

Hoshino A, Nakajima Y, Kawada K, Tokairin Y, Okada T, Matsui T . The Impact of Hybrid Minimally Invasive Esophagectomy with Neck-Abdominal First Approach on the Short- and Long-Term Outcomes for Esophageal Squamous Cell Carcinoma. World J Surg. 2020; 44(11):3829-3836. DOI: 10.1007/s00268-020-05655-3. View

15.

Newman M, Samson M . The application of laser-assisted indocyanine green fluorescent dye angiography in microsurgical breast reconstruction. J Reconstr Microsurg. 2008; 25(1):21-6. DOI: 10.1055/s-0028-1090617. View

16.

Blencowe N, Strong S, McNair A, Brookes S, Crosby T, Griffin S . Reporting of short-term clinical outcomes after esophagectomy: a systematic review. Ann Surg. 2012; 255(4):658-66. DOI: 10.1097/SLA.0b013e3182480a6a. View

17.

Kumagai Y, Ishiguro T, Haga N, Kuwabara K, Kawano T, Ishida H . Hemodynamics of the reconstructed gastric tube during esophagectomy: assessment of outcomes with indocyanine green fluorescence. World J Surg. 2013; 38(1):138-43. DOI: 10.1007/s00268-013-2237-9. View

18.

Nakajima Y, Kawada K, Tokairin Y, Hoshino A, Okada T . Flexible Gastric Tube: A Novel Gastric Tube Formation Method to Prevent Anastomotic Leakage. Ann Thorac Surg. 2020; 109(6):e445-e447. DOI: 10.1016/j.athoracsur.2019.12.084. View