Quantitative serosal and mucosal optical imaging perfusion assessment in gastric conduits for esophageal surgery: an exp
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and Other Interventional Techniques
2020 EAES ORAL
Quantitative serosal and mucosal optical imaging perfusion assessment in gastric conduits for esophageal surgery: an experimental study in enhanced reality Manuel Barberio1,2 · Eric Felli1 · Margherita Pizzicannella1 · Vincent Agnus1 · Mahdi Al‑Taher1 · Emilie Seyller1 · Yusef Moulla2 · Boris Jansen‑Winkeln2 · Ines Gockel2 · Jacques Marescaux1,3 · Michele Diana1,3,4,5 Received: 21 May 2020 / Accepted: 1 October 2020 © The Author(s) 2020
Abstract Introduction/objective Gastric conduit (GC) is used for reconstruction after esophagectomy. Anastomotic leakage (AL) incidence remains high, given the extensive disruption of the gastric circulation. Currently, there is no reliable method to intraoperatively quantify gastric perfusion. Hyperspectral imaging (HSI) has shown its potential to quantify serosal StO2. Confocal laser endomicroscopy (CLE) allows for automatic mucosal microcirculation quantification as functional capillary density area (FCD-A). The aim of this study was to quantify serosal and mucosal GC’s microperfusion using HSI and CLE. Local capillary lactate (LCL) served as biomarker. Methods GC was formed in 5 pigs and serosal StO2% was quantified at 3 regions of interest (ROI) using HSI: fundus (ROIF), greater curvature (ROI-C), and pylorus (ROI-P). After intravenous injection of sodium-fluorescein (0.5 g), CLE-based mucosal microperfusion was assessed at the corresponding ROIs, and LCLs were quantified via a lactate analyzer. Results StO2 and FCD-A at ROI-F (41 ± 10.6%, 3.3 ± 3.8, respectively) were significantly lower than ROI-C (68.2 ± 6.7%, p value: 0.005; 18.4 ± 7, p value: 0.01, respectively) and ROI-P (72 ± 10.4%, p value: 0.005; 15.7 ± 3.2 p value: 0.001). LCL value at ROI-F (9.6 ± 4.7 mmol/L) was significantly higher than at ROI-C (2.6 ± 1.2 mmol/L, p value: 0.04) and ROI-P (2.6 ± 1.3 mmol/L, p value: 0.04). No statistically significant difference was found in all metrics between ROI-C and ROI-P. StO2 correlated with FCD-A (Pearson’s r = 0.67). The LCL correlated negatively with both FCD-A (Spearman’s r = − 0.74) and StO2 (Spearman’s r = − 0.54). Conclusions GC formation causes a drop in serosal and mucosal fundic perfusion. HSI and CLE correlate well and might become useful intraoperative tools. Keywords Esophagectomy · Esophageal resection · Gastric conduit · Blood flow assessment · Perfusion assessment · Hyperspectral imaging · Confocal laser endomicroscopy · Enhanced reality Manuel Barberio and Eric Felli equally contributed to this manuscript. This study was accepted as a podium presentation at the European Association for Endoscopic Surgery and other Interventional Techniques (EAES) 28th Annual Meeting to be held in Krakow, Poland on June 24–27, 2020. It was then commuted into an e-Poster presentation for the 1st edition of the EAES Virtual Week Meeting. * Manuel Barberio manuel.barberio@ihu‑strasbourg.eu 1
Institute of Image‑Guided Surgery, IHU-Strasbourg, 1 place de l’Hôpital, 67091 Strasbourg, France
Department of Vis
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