Abstract
Introduction/objectiveGastric 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.MethodsGC was formed in 5 pigs and serosal StO2% was quantified at 3 regions of interest (ROI) using HSI: fundus (ROI-F), 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.ResultsStO2 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).ConclusionsGC formation causes a drop in serosal and mucosal fundic perfusion. HSI and CLE correlate well and might become useful intraoperative tools.
Highlights
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
The HYPER tool allowed for the precise identification of the regions of interest (ROI) onto the stomach surface, thereby guiding the Confocal laser endomicroscopy (CLE) scanning and Local capillary lactate (LCL) sampling successfully
StO2 measured in correspondence of ROI-F (41 ± 10.7%) was significantly lower than at ROI-C (68.2 ± 6.7%, p value: 0.005) and ROI-P (72 ± 10.4%, p value: 0.005)
Summary
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. The absence of a validated quantification method of the fluorescence signal is one of the main drawbacks to be solved before understanding the real impact of this technique on anastomotic complications. Hyperspectral imaging (HSI) is a contrast-free technology, which can provide a real-time snapshot of the chemical characteristics of a tissue. This imaging technique allows for tissue oxygen saturation (StO2) quantification and its utility during gastrointestinal procedures has been previously assessed [9,10,11]. HYPER results from the superimposition of the HSI-generated perfusion quantification pseudo-color map onto a real-time video of the surgical scene, thereby allowing for a precise spatial localization of the spectral information during surgical procedures. CLE potentially provides a precise snapshot of the tissue microcirculation, simultaneously giving a morphological in vivo histopathological appraisal and computing the functional capillary density area (FCD-A) index or the speed of red blood cells [15,16,17]
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