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2 results on '"GASTRIC TUBE PERFUSION"'

1. Quantification of gastric tube perfusion following esophagectomy using fluorescence imaging with indocyanine green.

Author

von Kroge, Philipp, Russ, Detlef, Wagner, Jonas, Grotelüschen, Rainer, Reeh, Matthias, Izbicki, Jakob R., Mann, Oliver, Wipper, Sabine H., and Duprée, Anna

Subjects
*INDOCYANINE green, *FLUORESCENCE, *ESOPHAGECTOMY, *ESOPHAGEAL cancer, *PERFUSION, *POLYPOIDAL choroidal vasculopathy, *TUBES, *GASTRIC bypass
Abstract

Introduction: Anastomotic leakage (AL) remains a prevalent and life-threatening complication after esophagectomy. Gastric tube perfusion assessment using indocyanine green fluorescence imaging (ICG-FI) has been published in several studies and appears to be a promising tool to reduce AL rates by changing the surgical approach, namely by an intraoperative evaluation of the anastomosis localization. Methods: In this study, gastric tube perfusion was quantified by using ICG-FI in 20 high-risk patients undergoing esophagectomy. From a time-dependent fluorescence intensity curve, the following three parameters were evaluated: slope of fluorescence intensity (SFI), background subtracted peak fluorescence intensity (BSFI), and time to slope (TTS). Results: The values between pyloric region and tip showed a similar downward trend and SFI and BSFI significantly correlated with the distance to the pyloric region. SFI and BSFI were significantly decreased at the tip of the gastric tube. The placement of anastomosis in an area with homogenous fluorescence pattern was correlated with no AL in 92.9% of cases. An inhomogeneous fluorescence pattern at anastomotic site was a risk factor for the occurrence of an AL (p < 0.05). Reduction of perfusion up to 32% using SFI and up to 23% using BSFI was not associated with AL. Conclusion: ICG-FI can be used to quantify the gastric tube perfusion by calculating SFI, BSFI, and TTS. The anastomosis should be created in areas with homogeneous fluorescence pattern. A reduction in blood flow of up to 32% can be accepted without causing an increased rate of insufficiency. [ABSTRACT FROM AUTHOR]

Published
2022
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2. Assessment of graft perfusion and oxygenation for improved outcome in esophageal cancer surgery: Protocol for a single-center prospective observational study

Author

Wouter Willaert, Anne Hoorens, Oswald Varin, Elke Van Daele, Dirk Van de Putte, Piet Pattyn, Bart P. Braeckman, Christiaan Vanhove, Wim Ceelen, Yves Van Nieuwenhove, and Jurgen Van Limmen

Subjects
Esophageal Neoplasms, medicine.medical_treatment, Hemodynamics, Perfusion scanning, Anastomotic Leak, stomach graft, chemistry.chemical_compound, 0302 clinical medicine, Ischemia, Study Protocol Clinical Trial, Medicine and Health Sciences, Prospective Studies, Prospective cohort study, PREDICTORS, Coloring Agents, Hypoxia, medicine.diagnostic_test, Angiography, General Medicine, Esophagectomy, GASTRIC TUBE PERFUSION, Research Design, 030220 oncology & carcinogenesis, SURVIVAL, 030211 gastroenterology & hepatology, Radiology, ENHANCED REALITY, oxygenation, Perfusion, indocyanine green angiography, Research Article, EXPRESSION, Indocyanine Green, medicine.medical_specialty, ANASTOMOTIC LEAKAGE, CARCINOMA, FACTOR 1-ALPHA, anastomotic leakage, perfusion, 03 medical and health sciences, MORBIDITY, near-infrared fluorescence imaging, medicine, Humans, business.industry, MORTALITY, Perioperative, chemistry, esophagectomy, business, Indocyanine green, Biomarkers
Abstract

Introduction: The main cause of anastomotic leakage (AL) is tissue hypoxia, which results from impaired perfusion of the pedicle stomach graft after esophageal reconstruction. Clinical judgment is unreliable in determining graft perfusion. Therefore, an objective, validated, and reproducible method is urgently needed. Near infrared fluorescence perfusion imaging using indocyanine green (ICG) is an emerging and promising modality. This study's objectives are to evaluate the feasibility of quantification of ICG angiography (ICGA) to assess graft perfusion and to validate ICGA by comparison with hemodynamic parameters, blood and tissue expression of hypoxia-induced markers, and tissue mitochondrial respiration rates. And, second, to evaluate its ability to predict AL in patients after minimally invasive esophagectomy (MIE). Methods: Patients (N = 70) with resectable esophageal cancer will be recruited for standard MIE. ICGA will be performed after graft creation and thoracic pull-up. Dynamic digital images will be obtained starting after intravenous bolus administration of ICG. The resulting images will be subjected to curve analysis and to compartmental analysis based on the adiabatic approximation to tissue homogeneity kinetic model. The calculated perfusion parameters will be compared to intraoperative hemodynamic data to evaluate the effects of patient hemodynamics. To verify whether graft perfusion represents tissue oxygenation, ICGA perfusion parameters will be compared with systemic and serosa lactate from the stomach graft. In addition, perfusion parameters will be compared to tissue expression of hypoxia-related markers and mitochondrial chain respiratory rate. Finally, the ability of functional, histological, and cellular perfusion and oxygenation parameters to predict AL and postoperative morbidity in general will be evaluated using the appropriate univariate and multivariate statistical analyses. Discussion: The results of this project may lead to a novel, reproducible, and minimally invasive method to objectively assess perioperative anastomotic perfusion during MIE, potentially reducing the incidence of AL and its associated severe morbidity and mortality. Trial registration: Clinicaltrials.gov registration number is NCT03587532. The study was approved by the ethical committee of the Ghent University, Belgium (B670201836427).

Published
2018

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