Ischemic Conditioning of the Gastric Conduit Prior to Esophagectomy Improves Mucosal Oxygen Saturation

Abstract

Ischemic conditioning of the gastric conduit is considered as a possible approach to improve perfusion of the gastric tube after esophagectomy. The aim of this study was to assess the impact of ischemic conditioning on gastric microcirculation in a clinical setting. Nineteen patients with an esophageal carcinoma were included. In a first laparoscopic procedure, the stomach was devascularized by complete gastric mobilization including ligation of the left gastric artery ("laparoscopic gastrolysis"). After a delay of 4 to 5 days, all patients underwent a transthoracic esophagectomy and reconstruction with the prepared gastric conduit (Ivor-Lewis). Mucosal oxygen saturation (MOS, sulfur dioxide in %) was quantitatively measured from the endoluminal side in well-defined areas of the antrum, corpus, and fundus using a tissue spectrometer located at the tip of a microprobe (LEA, Medizintechnik, Giessen, Germany). Under general anesthesia, sulfur dioxide measurement I was taken before, and measurement II after laparoscopic gastric mobilization; measurement III was done before esophagectomy and reconstruction 4 to 5 days later. Before laparoscopic mobilization of the stomach the median MOS of the fundus was 72% (range, 49% to 86%). The MOS significantly decreased after devascularization of the stomach (median MOS, 38%; range, 9% to 86%). After 4 to 5 days, MOS almost recovered to values observed before gastric mobilization (median MOS, 62%; range, 48% to 85%). Compared with the fundus, no significant sulphur dioxide changes were detected in the corpus and antrum. This study demonstrates that ischemic conditioning influences microcirculation of the gastric conduit and improves MOS in the anastomotic region at the time of reconstruction.