Abstract
Abstract Aim The aim of this review was to evaluate feasibility and effectiveness of Indocyanine green fluorescence angiography (ICGA) as an assessment tool for gastric tube (GT) perfusion during the construction of the esophago-gastric anastomosis, and as a predictor of anastomotic leakage (AL). Moreover, attention was given to attempts made to quantify this method in esophageal surgery. Background & Methods After an esophagectomy, a GT is most commonly used to restore continuity of the upper gastrointestinal tract. Esophago-gastric anastomoses are known for their complications such as AL, associated with high morbidity and mortality. Graft perfusion is an important predictor for anastomotic integrity. Tissue perfusion assessment is currently based on subjective parameters as tissue color and vessel pulsations. Near infrared fluorescent (NIRF) imaging is an emerging medical imaging modality, requiring penetrating NIR light that excites a NIRF agent within the tissue, generating fluorescence that can then be captured by adapted cameras. Indocyanine green Angiography (ICGA) is such a NIRF imaging technique which can be used as a method to visualize anastomotic perfusion. For this review, 2 reviewers independently searched Pubmed and Embase for studies evaluating intraoperative ICGA perfusion assessment of the GT. Feasibility, complications, intraoperative surgical changes based on ICGA findings, quantification attempts, anatomical data and the impact of ICGA on postoperative anastomotic complications were documented and further analyzed. Results Nineteen studies were included for qualitative analyses. All described ICGA as a safe and easy method for gastric graft perfusion assessment. AL occurred in 13.8% of the entire cohort, 10% in the ICG guided group and 20.6% in the control group (p<.001). AL in the well-perfused group was 6.3% vs. 20.5% in the control group without ICGA (p< .001). The group with an altered surgical plan based on the ICG image had similar AL rates as the well perfused group (6.5% vs. 6.3%) and significantly less than the poorly perfused group (47.8%) (p<.001), suggesting that the technique is able to identify and alter a potential bad outcome. Conclusion the present review suggest that ICGA is a safe and easy method for GT perfusion assessment. Differences in AL rate between the well perfused and poor perfused anastomotic sites suggest that a good fluorescent signal is a predictor of good outcome.
Published Version
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