Gastric Blood Supply Research Articles

ASO Visual Abstract: Selective Gastrectomy with Knowledge of Gastric Anatomy and Blood Supply are Key to Complete Tumor Removal in Advanced Pseudomyxoma-Single Center Experience with 120 Gastrectomies Over 20 Years.

ASO Visual Abstract: Selective Gastrectomy with Knowledge of Gastric Anatomy and Blood Supply are Key to Complete Tumor Removal in Advanced Pseudomyxoma-Single Center Experience with 120 Gastrectomies Over 20 Years.

Selective Gastrectomy with Knowledge of Gastric Anatomy and Blood Supply are Key to Complete Tumour Removal in Advanced Pseudomyxoma: Single-Centre Experience with 120 Gastrectomies Over 20 Years.

The role of gastrectomy to achieve complete cytoreduction (CCR) for pseudomyxoma peritonei (PMP) is controversial due to uncertain risk/benefit ratio. The outcomes of patients who gastrectomy over a twenty-year period in a high-volume unit are reported. All patients requiring gastrectomy to achieve CCR for appendiceal PMP between 2000 and 2020 were reviewed. Demographics, disease, operative, complication, and survival data were analysed. The first and second decades were compared. A total of 2148 patients underwent CRS and HIPEC, of which 78% had CCR. Gastrectomy was performed in 7.1%. Median age was 55 years, and 52% were female. Among gastrectomy patients, 94.2% had ≥1 elevated tumour marker, and 18% had high-grade disease. Median PCI was 30, and 30% required subtotal colectomy. Clavien-Dindo III-IV complications occurred in 32%, and 90-day mortality was 1.75%. Median survival was 104 months, and 10-year OS was 47%. Comparing the two decades, total CRS cases almost tripled, with a greater proportion achieving CCR (82.2% vs. 67.8%) but fewer requiring gastrectomy (5.3% vs. 13.5%). In those who had gastrectomy, disease was more advanced (higher PCI, more high-grade disease, more colectomies) in the later period. However, on multivariable analysis, there was no difference in survival between decades. High-grade histology was the only predictor of survival. Gastrectomy can achieve good long-term survival with low mortality and acceptable morbidity and should not deter surgeons from achieving CCR. However, increasing experience shows CCR can be achieved, preserving the stomach in the majority of cases through careful consideration of the anatomy and gastric blood supply.

Assessment of arterial supply to the stomach after bariatric surgery using multidetector CT arteriography.

To describe residual arterial supply to the stomach after bariatric surgery via a systematic arterial-phase CT assessment approach that can aid in diagnosis and treatment of postoperative complications and facilitate planning for future procedures. Arterial-phase CT of 46 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at 3 academic institutions were retrospectively reviewed to assess patency of left gastric artery (LGA), right gastric artery (RGA), gastroepiploic artery (GEA), and left inferior phrenic artery (LIPA) and presence of gastric perforators. In 25 RYGB and 21 SG patients, mean diameters were LGA 2.2 ± 0.4mm, RGA 1.6 ± 0.5mm, and GEA 1.7 ± 0.4mm. On RYGB scans, all LGAs, RGAs, and 24/25 (96%) of GEAs were identified. Excellent to good patency was seen in 20/25 (80%) LGAs, 21/25 (84%) RGAs, and 23/24 (96%) GEAs. On SG scans, all LGAs, 18/21 (86%) of RGAs, and 20/21 (95%) GEAs were identified. Excellent to good patency was seen in 17/21 (81%) LGAs, 15/18 (83%) RGAs, and 20/20 (100%) GEAs. In terms of gastric perforators, LGA supply was seen on 23/25 (92%) of RYGB and 17/17 (100%) of SG scans. RGA supply was seen on 13/21 (62%) RYGB and 9/18 (50%) SG scans. GEA supply was seen on 19/23 (83%) RYGB scans. No gastric supply via GEA was seen on SG scans. In this study, arterial supply to the stomach through the LGA was consistently identified in all RYGB and SG cases, indicating an uncomplicated surgical approach with regard to preserving the LGA. Dedicated CT angiography protocol or catheter-directed angiography is recommended for accurate and comprehensive assessment of the gastric blood supply, particularly before surgical re-intervention.

Video-fluorescence navigation by PpIX and tissue saturation measurement during surgical resection of gastric malignant tumor

SignificanceThe quality of the anastomosis is an important factor influencing the outcome of the surgical operation. Since it provides a reliable connection of sutured biological tissues, it is necessary to control the consistency of the anastomosis in order to prevent complications after the operation. Fluorescence diagnostics makes it possible to determine the localization of the tumor and residual pathological tumor tissues after resection by the intensity of the photosensitizer fluorescence accumulated in tissue, which can be missed during visual examination. ApproachFluorescence diagnostics was performed using a diode laser with a wavelength of 635 nm, which is at the absorption peak of the photosensitizer protoporphyrin 9 (PpIX). The assessment of the StO2 level was carried out spectroscopically using white broadband radiation. ResultsThe tissue blood supply was assessed. Patients with stomach resection underwent fluorescent diagnostics using PpIX. The localization of the tumor and pathological tumor sites after partial resection of the stomach was determined. The change in the level of StO2 at each stage of the operation was determined. ConclusionsFluorescent diagnostics using PpIX and joint determination of StO2 by diffuse scattering spectroscopy improved the quality of tumor resection and assessed the state of gastric tissue blood supply in real time.

Assessment of gastric pouch blood supply with indocyanine green fluorescence in conversional and revisional bariatric surgery: a prospective comparative study

Our study aimed to evaluate the usefulness of indocyanine green (ICG) angiography during conversional or revisional bariatric surgery. We prospectively enrolled all patients scheduled for reoperative bariatric surgery with gastric pouch resizing and ICG assessment and we compared them with a retrospective series of similar patients who did not receive ICG. The primary outcome was the rate of intraoperative change in the surgical strategy due to the ICG test. We included 32 prospective patients receiving intraoperatively an ICG perfusion test and 48 propensity score-matched controls. The mean age was 50.7 ± 9.7 years, 67 (83.7%) patients were female, and the mean BMI was 36.8 ± 5.3 kg/m2. The patient characteristics were similar in both groups. The ICG angiography was successfully conducted in all patients, and no change of the surgical strategy was necessary. Postoperative complications were similar in both groups (6.2% vs. 8.3%, p = 0.846), as well as operative time (125 ± 43 vs. 133 ± 47 min, p = 0.454) and length of hospital stay (2.8 ± 1.0 vs. 3.3 ± 2.2 days, p = 0.213). Our study suggested that ICG fluorescence angiography might not have been useful for assessing the blood supply of the gastric pouch in patients who underwent reoperative bariatric surgery. Therefore, it remains uncertain whether the application of this technique is indicated.

Quantification of gastric mucosal microcirculation as a surrogate marker of portal hypertension by spatially resolved subdiffuse reflectance spectroscopy in diagnosis of cirrhosis: a proof-of-concept study

Background and Aims:Portal pressure can be used to identify patients with chronic liver disease who have progressed to cirrhosis. Portal pressure can also provide accurate prognostication for patients with cirrhosis. However, there are no practical means for assessment of portal pressure. Although it is well established that the gastric mucosal blood supply increases in patients with cirrhosis, this has been difficult to quantify reproducibly. Our group has developed a novel spectroscopic technology called spatially resolved subdiffuse reflectance spectroscopy (SRSRS), which enables quantification of mucosal microcirculation. We aim to ascertain if quantification of the gastric mucosal microcirculation with SRSRS correlates with clinical evidence of portal hypertension.Methods:Patients undergoing EGD for clinical indications had 10 measurements taken in the endoscopically normal gastric fundus via SRSRS probe to assess the microcirculation. Cases were defined as patients with cirrhosis (n = 18), and controls were those without evidence of liver disease (n = 18); this was corroborated with transient elastography.Results:The blood volume fraction (P = .06) and subdiffuse reflectance (P = .02) from a shallow depth in the gastric fundus were higher in patients with cirrhosis than those without. These markers were combined to yield an overall optical marker that can differentiate patients with cirrhosis from controls with a sensitivity of 72% and specificity of 94% (area under receiver operating curve, 0.82).Conclusions:Spectroscopic quantification of gastric fundal mucosal microcirculation is a promising surrogate of clinical correlates of portal hypertension. This approach may represent a less-intrusive surrogate biomarker for liver disease prognostication and potentially response to therapy.

D2 Lymphadenectomy According to the Arterial Variations in Gastric and Hepatic Irrigation.

D2 lymphadenectomy for gastric cancer is technically demanding and requires clearance of the lymph node stations along the main arteries that irrigate the stomach and the liver. As gastric and hepatic irrigation have a different pattern from the classic branching of the celiac trunk in approximately 25% of patients, acquaintance with these variations and knowledge on how to adequately perform the lymphadenectomy in different anatomic settings is of utmost importance for surgeons who manage gastric cancer.1 METHODS: This video demonstrates, step-by-step, how to perform D2 lymphadenectomy in accordance with gastric and hepatic irrigation. Illustrations of the arterial variation correlate with the corresponding computed tomography image and operative management of the lymph node stations. D2 lymphadenectomy is the standard of care in advanced gastric cancer.2 It implies clearing the lymph node stations along the celiac trunk, left gastric artery, and common and proper hepatic arteries. However, the celiac trunk and hepatic irrigation are highly variable and surgeons must be aware of how to properly and safely address the lymph node stations in all scenarios. Vessel anatomical variations increase the risk of vascular injuries and its complications, such as bleeding, necrosis, liver function impairment, liver necrosis, and conversion to open surgery.3-5 Additionally, the lymphadenectomy cannot be compromised if a variation is found.6 Preoperative knowledge of the gastric blood supply also shortens the surgical duration.7 CONCLUSIONS: The present video demonstrates how to recognize the most common variations found during D2 gastrectomy, and provides strategies to adequately approach them.

Uremic and Post-Transplant Gastropathy in Patients With Chronic Kidney Disease and End-Stage Renal Disease.

Gastrointestinal (GI) mucosal lesions are common in chronic kidney disease (CKD), end-stage renal disease (ESRD), and in post-renal transplant period. However, etiology of mucosal lesions pre- and post-transplant is very different. Gastropathy in non-transplant ESRD patients usually develops because of uremia, chronic anemia, and fluctuations in the gastric blood supply during hemodialysis, eventually leading to uremic gastritis. Gastropathy in post-transplant patients tends to be associated with immunosuppressive therapies.Helicobacter pylori infection is more prevalent in uremic patients than in post-transplant patients. Uremia can also lead to uremic arteriolopathy and autonomic nervous system dysfunction, which can present with GI symptoms mimicking uremic gastropathy. Post-transplantation immunosuppressive therapies have been linked to GI mucosal lesions as well. These lesions carry a poor prognostic factor disrupting the function of the GI tract, which in turn affects the pharmacokinetics of the immunosuppressive drugs eventually leading to poor graft survival and increased mortality. Mycophenolate mofetil is one of the agents more associated with intestinal erosions.Recognizing uremic gastropathy and intervening early helps prevent post-transplant GI complications. Acid controlling therapies can be an effective prophylaxis against both gastropathies. Using enteric-coated formulation for immunosuppressive agents may slow down the mucosal insult. Treatment of H. pylori in both patient populations may help prevent further mucosal injury. Lastly, timely screening for symptoms may help start treatment early and prevent progression to serious gastropathy.

Prevalence of anastomotic leak and the impact of indocyanine green fluorescein imaging for evaluating blood flow in the gastric conduit following esophageal cancer surgery

Backgrounds and aimAnastomotic leak (AL) following esophagectomy for esophageal cancer (EC) remains an important cause of prolonged hospitalization and impaired quality of life. Recently, indocyanine green (ICG) fluorescein imaging has been used to evaluate the gastric conduit blood supply during EC surgery. Although several factors have been reported to be associated with AL, no studies have evaluated the relationships between risk factors for AL, including ICG fluorescein imaging. The purpose of this study was to investigate the risk factors associated with AL following esophagectomy and to evaluate the impact of ICG fluorescein imaging of the gastric conduit during EC surgery.MethodsOne hundred and twenty patients undergoing esophagectomy with esophagogastric anastomosis for EC were enrolled in this retrospective study. Clinicopathological factors, preoperative laboratory variables, and surgical factors, including ICG fluorescence imaging, were analyzed to determine their association with AL. Univariate and multivariate logistic regression analysis was used to evaluate the impact of each of these factors on the incidence of AL.ResultsAmong the 120 patients enrolled in the study, 10 (8.3%) developed AL. Univariate analysis demonstrated an increased risk of AL in patients with a high-neutrophil-to-lymphocyte ratio (p = 0.0500) and in patients who did not undergo ICG fluorescein imaging (p = 0.0057). Multivariate analysis revealed that the absence of ICG imaging was an independent risk factor for AL (p = 0.0098).ConclusionsUsing ICG fluorescein imaging to evaluate blood flow in the gastric conduit might decrease the incidence of AL following EC surgery.

食道癌術後の膵癌に対する膵頭十二指腸切除術術後出血による再手術にてindocyanine green蛍光法を用いた胃管血流評価が有用であった1例

症例は70歳の男性で，7年前に食道癌に対し胸部食道亜全摘，胸骨後経路胃管再建術を施行され，再発なく経過していた．今回，黄疸の精査で遠位胆管の狭窄所見を認め，同部からの生検でadenocarcinomaを検出し膵頭部癌と診断され，術前化学療法施行後に切除術を行った．術式は，右胃動脈（right gastric artery；以下，RGAと略記），胃十二指腸動脈，右胃大網動脈（right gastroepiploic artery；以下，RGEAと略記）を温存した，幽門輪温存膵頭十二指腸切除術を施行した．術後5日目に幽門下動脈断端の仮性動脈瘤破裂を来し，RGEAのコイル塞栓術を施行した．翌日縫合不全が明らかとなり再手術を施行した．十二指腸空腸吻合部縫合不全による腹腔内膿瘍が，仮性動脈瘤の形成，破裂をじゃっ起したと考えられた．結果的に胃管血流はRGA単独となったが，術中indocyanine green（以下，ICGと略記）蛍光法による胃管血流評価を行い，術後は胃管壊死なく経過した．RGA単独による胃管温存の報告は極めて少なく，胃管血流評価にはICG蛍光法が有用と考えられた．

Gastric lymph node stations

Due to the low incidence of gastric cancer in the United States, it is hard for residents to fully appreciate the complexity of the anatomy associated with peri-gastric lymph node stations ( Figure 1 ). This video clip reviewed the relevant gastric blood supply ( Table 1, Figure 2 ) and the corresponding lymph node stations ( Figure 2 ). The primary goal of this article is to provide residents an intuitive way to understand the peri-gastric lymph node network in order to facilitate the teaching of appropriate gastric cancer surgery.

Evaluation of gastric blood supply in diabetic patients with gastroparesis by contrast-enhanced ultrasound.

Improvement in regional blood flow has been shown to ameliorate diabetic gastroparesis. We compared the gastric blood supply in patients with diabetes with gastroparesis with that in healthy subjects, by using contrast-enhanced ultrasound (CEUS). 30 healthy subjects and 40 patients with diabetic gastroparesis were enrolled. The CEUS parameters of greater curvatures of the antrum (GCOA) and lesser curvatures of the antrum (LCOA), including peak intensity (PI) and the area under the curve (AUC), were compared between the two groups. Intraclass correlation coefficient (ICC) for PI in healthy subjects measured on CEUS were 0.831-0.857 and 0.803-0.823, respectively. Intra-ICC and inter-ICC values for AUC were 0.805-0.823 and 0.813-0.815, respectively. In both groups, no significant difference was observed in PI and AUC values of GCOA and LCOA (p > 0.05). The PI and AUC of GCOA and LCOA in the diabetes group were less than those in the normal group (p < 0.05). CEUS can assess stomach wall vascularity with a high reproducibility. Microcirculation in the antrum of patients with diabetic gastroparesis is poorer than that of normal group, which is consistent with the mechanisms of diabetic neuropathy. CEUS can be used for evaluation of microvascular perfusion in patients with stomach wall disease. Advances in knowledge: This was the first study to use CEUS for assessment of blood supply of the gastric wall and to compare microvascular perfusion between healthy individuals and patients with diabetes with gastroparesis.

Evaluation of pH Triggers in situ Porous Controlled Release Micro Balloon Delivery of Amoxicillin for Eradication of Helicobacter pylori

Helicobacter pylori reside in the gastric mucus layer and at the mucus-epithelial cell interface wherein access of antimicrobial drug to the infection site is restricted both from the stomach and from the gastric blood supply. The aim of the present study was to develop pectin or gellan gum blended sodium alginate microspheres in order to eradicate gastric Helicobacter pylori. The percentage drug release and mucoadhesion were decrease on increasing the calcium chloride in the formulation dispersion. Curing time significantly effected encapsulation efficiency and was not affected % drug content, % buoyancy, and particle size and drug release. The efficacy of the optimized formulation was evidenced by absence of amplified bacterial gene in treated stomach tissue of Mongolian gerbils as observed using in polymerase chain reaction. The results demonstrate that the developed formulation of Am has potential to eradicate Helicobacter pylori by targeted and prolonged retention at gastric mucosa.

Utility of preoperative visualization for intrapulmonary sequestration in video-assisted thoracoscopic surgery

We herein report the case of a 59-year-old male suffering from severe cough. The patient had previously experienced several episodes of pneumonia beginning in childhood. A three dimensional multidetector computed tomography (3D-MDCT) scan revealed pulmonary sequestration with a left gastric artery blood supply, and clearly revealed the other pulmonary vessels. The patient underwent video-assisted thoracoscopic surgery, in which the anomalous tissue was resected safely. Preoperative visualization of the vessels may be helpful for the safe treatment of a pulmonary sequestration, and the VATS approach is a suitable operation under corrective surgical planning.

Gastro-Duodenal Lesions and Helicobacter pylori Infection in Uremic Patients and Renal Transplant Recipients

Background Upper gastrointestinal (UGI) symptoms are common in uremic patients, and higher serum levels of urea have been suggested to be related to Helicobacter pylori (HP) colonization and UGI mucosal inflammation. Aim The aim of this study was to compare HP infection and UGI endoscopic findings between uremic patients, renal transplant (RT) recipients, and controls. Methods A total of 474 subjects (71 chronic renal failure [CRF], 73 hemodialysis [HD], 25 Tx, and 305 controls) from Baqyiatallah Hospital, Tehran, Iran were recruited between April 2002 and March 2004 for evaluation of dyspepsia, excluding those receiving any HP-eradication therapy. All subjects were examined for esophagus, stomach and duodenum mucosa, and infection with HP on 2 distinct tissue samples of the anthral region. Results Four groups of subjects (mean ± 2 se; age, 45 ± 1.6 years; 62.9% male) were studied. Duodenal ulcer in the uremic patients (CRF, 16.1%; HD, 13.7%) was more common than that in the RT-recipients (8%) and controls (6.5%); P = .038. Erosive gastritis and duodenal bulb deformity were also more common in the uremic subjects (CRF, 23.9%, 36.9%; HD, 30.1%, 20.5%, respectively) than those in the other subjects (RT recipients, 16%, 8%; controls, 8.2%; 0%, respectively); P < .001. HP infection was found to be higher in the uremic patients (CRF, 66.2%; HD, 63%) than in the RT recipients (40%) and controls (34.8%); P < .001. Conclusion Higher rates of gastric and duodenal mucosal lesions and HP infection in the uremic patients in comparison with the subjects with normal renal function may have resulted from higher serum levels of urea, anemia, and fluctuations in the gastric blood supply in the CRF and HD patients. However, more tenable evidence from controlled trials is required for the eradication of HP in all uremic patients and transplantation candidates.

An evaluation of the effect of a gastric ischemia–reperfusion model with laser Doppler blood perfusion imaging

The objectives of this study are to establish a gastric ischemia-reperfusion model and test it using the laser Doppler blood perfusion imaging (LDPI) method and to evaluate the role of the LDPI technique in the measure of gastric blood circulation. The right gastric artery of the rat was clamped for 30 min and then reperfused. The LDPI was used to display the blood circulation of the whole gastric surface during this process. The blood flow perfusion image of the gastric surface was displayed clearly. After the right gastric artery was clamped, the blood flow perfusion on the gastric surface decreased very significantly until the clamp was loosened. Following reperfusion, the blood flow suddenly increased. Within the first 10 min, the blood-flow perfusion exceeded the level before the clamping and then gradually became smooth and steady. The right gastric artery is a main pathway for gastric blood supply. LDPI can display successfully the blood circulation state of the stomach and the course of ischemia-reperfusion of a large area with an image.

Noninvasive evaluation of gastric tube blood supply with multislice computed tomography

1010-7940/$ — see front matter # 2006 Published by Elsevier B.V. doi:10.1016/j.ejcts.2006.03.061 A 57-year-old man with esophageal carcinoma underwent total esophagectomy and cervico-abdominal reconstruction using a gastric tube. One year after surgery, a multislice computed tomography (MSCT) scan was able to evaluate the blood supply to the gastric tube by right gastroepiploic artery (Figs. 1 and 2).

Postoperative gastric ischaemia.

This review discusses postoperative gastric ischaemia after detailed consideration of the gastric blood supply and the effects of devascularization. Special consideration is given to gastric remnant necrosis, lesser curve ischaemia after highly selective vagotomy, and gastric ischaemia after other operations.

Gastrostomy placement in patients with Crohn's disease.

Crohn's disease often involves the stomach, yet a permanent enterocutaneous fistula does not usually occur, after a percutaneous endoscopic gastrostomy is removed from a patient with Crohn's disease. This is because the factors that are related to the non-closure of a fistula are absent or have been treated (distal bowel obstruction, abdominal sepsis, undernutrition, poor gastric blood supply or abnormal serum levels of C-reactive protein and albumin). Gastric involvement in patients with Crohn's disease is common. Enterocutaneous fistulas from the stomach are rare. Percutaneous endoscopic gastrostomy (PEG) insertion and subsequent removal rarely cause problems in patients with Crohn's disease. Endoscopic removal of a PEG is advised in patients with Crohn's disease. Steroids may delay gastric adhesion to the anterior abdominal wall.

Efficacy of gastric blood supply redistribution by transarterial embolization: preoperative procedure to prevent postoperative anastomotic leaks following esophagoplasty for esophageal carcinoma.

The aim of this study was to evaluate the effect of preoperative redistribution of gastric blood supply on the prevention of anastomotic leakage following surgical reconstruction of the esophagus. In 37 patients with esophageal carcinoma, transarterial embolization (TAE) of the left gastric, right gastric, and splenic arteries was preoperatively performed with coils so that gastric blood supply was dependent only on the right gastroepiploic artery. In 34 of 37 patients, preoperative redistribution was successfully performed. The gastric tissue blood flow (TBF) of a gastric tube was higher than in 12 nonredistributed patients. Reduction in the gastric TBF during preparation of a gastric tube was 27.5% in successful patients, in contrast to 68.9% in 12 nonredistributed patients (p < 0.005). Preoperative redistribution by TAE reduced the drop in gastric TBF during preparation of a gastric tube and helped prevent postoperative anastomotic leakage in esophageal reconstruction.