Quantification of the micoperfusion of gastric tube using fluorescence imaging with Indocyanine green

Introduction The incidence of esophageal cancer is increasing. Surgical treatment continues to be the therapy of choice in resectable stages of esophageal cancer. Despite technical improvement with minimal invasive therapeutic approaches, anastomotic leakage (AL) remains a prevalent and threatening complication after esophagectomy. The evaluation of gastric tube perfusion using fluorescence imaging with indocyanine green (ICG-FI) has been published in several studies and is a promising tool regarding the reduction of AL. However, the described use of technology is merely subjective.

Aim Aim of the present study is the evaluation and quantification of the microperfusion of the gastric tube using ICG-FI.

Methods In eleven patients with esophageal cancer an esophagectomy was performed. For reconstruction, a gastric tube was created. ICG-FI of the gastric tube using SPY Elite (NOVODAQ) was performed intraoperatively, FI was evaluated postoperatively and a time dependent fluorescence intensity curve was generated. Three parameters were calculated: The slope of fluorescence intensity (SFI), the background subtracted peak fluorescence intensity (BSFI) and the time to slope (TTS).

Results SFI and BSFI were significantly decreased at the tip of the gastric tube. The values in between showed a downward trend likewise. SFI and BSFI significantly correlated with the distance to the pyloric region. Mostly, the tube showed homogenous fluorescence pattern up to a line of demarcation. Values adjacent to the line showed a significant difference. SFI and BSFI were significantly lower in the post-demarcation area. TTS was significantly prolonged at the tip of the tube. If the anastomosis could be placed in a pre-demarcation area with homogenous fluorescence pattern, no leakage occurred. Fluorescence pattern at anastomotic side was a risk factor for the occurrence of an AL (p = 0,024). Perfusion measured by SFI and BSFI could be reduced by 60 % and 48 % without being associated with AL.

Conclusion The calculated parameters SFI, BSFI and TTS confirmed the expected perfusion pattern, and therefore can predict the local intensity of tissue perfusion. ICG-FI might be a promising tool in evaluation of anastomotic perfusion after esophagectomy.

Publication History

Article published online:
07 September 2021