Correlation between indocyanine green visualization time in the gastric tube and postoperative endoscopic assessment of
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ORIGINAL ARTICLE
Correlation between indocyanine green visualization time in the gastric tube and postoperative endoscopic assessment of the anastomosis after esophageal surgery Hiroyuki Kitagawa1 · Tsutomu Namikawa1 · Jun Iwabu1 · Keiichiro Yokota1 · Sunao Uemura1 · Masaya Munekage1 · Kazuhiro Hanazaki1 Received: 9 March 2020 / Accepted: 16 April 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose To evaluate the correlation between blood supply speed in the gastric tube (GT), assessed by the intraoperative indocyanine green (ICG) fluorescence method, and postoperative endoscopic assessment (PEA) of the anastomosis or anastomotic leakage (AL). Methods The subjects of this retrospective analysis were 66 consecutive patients who underwent GT reconstruction using ICG fluorescence during esophageal surgery. We measured the ICG visualization time, from ICG injection to visualization at the top of the GT. We performed PEA on 54 patients and classified ulcer formation as involving less than or more than half of the circumference. Results PEA revealed that nine patients (16.7%) had an anastomotic ulcer involving more than half of the circumference and ten (15.4%) had AL. The ICG visualization time in these patients was significantly delayed compared with that in those with less than half of the circumference involved by ulcer formation (37 s vs. 27 s; P = 0.015) and without AL (36 s vs. 28 s; P = 0.045). Multivariate analysis revealed that delay in the ICG visualization time (> 36 s) of the pulled-up GT (odds ratio, 6.098; 95% confidence interval, 1.125–33.024; P = 0.036) was an independent risk factor associated with AL. Conclusion Delay in the ICG visualization time of pulled-up GT was associated with ulcer formation on the anastomosis and AL after esophageal surgery. Keywords Intraoperative indocyanine green (ICG) · Gastric tube · Endoscopic assessment · Anastomotic leakage, esophageal surgery
Introduction Gastric tube (GT) reconstruction is a common procedure during esophagectomy because the stomach has rich vessel networks in the wall [1]; however, it is associated with an anastomotic leakage (AL) rate of more than 10% [2], resulting in a number of sequelae, including increased costs [3]. The risk factors for AL include comorbidities [4], preoperative radiation [5], and surgical techniques such as those designed to preserve blood supply to the stomach and place less tension on the anastomosis.
We reported previously that the indocyanine green (ICG) fluorescence method could reveal the blood supply in the GT [6], and that better intraoperative ICG visualization was associated with improved postoperative endoscopic assessment (PEA) of the anastomosis [7]. However, as intraoperative ICG visualization is subjective, we need to establish objective criteria. The speed of the bloodstream in the GT might reflect the ICG state [8]. Thus, we conducted the present study to evaluate the correlation between ICG visualization speed in the GT and PEA of the anastomosis or AL during esophageal surgery.
* Tsutom
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