ICG‐fluorescence angiography assessment of colon interposition for oesophageal cancer – A Video Vignette

Galema, Hidde A.; Rees, Jan M. van; Matthijsen, Robert A.; Hilling, Denise E.; Wijnhoven, Bas P. L.; Lagarde, Sjoerd M.

doi:10.1111/codi.16076

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“… 13 Recently, a video vignette by Galema and a case study by Gupta described the feasibility of ICG-FA in colonic interposition. 14 , 15 This study is the first cohort study to assess the role of ICG-FA to assess perfusion in colonic segments. The ICG-FA assessment confirmed adequate perfusion of the colonic conduit and its chosen vascular pedicle, and induced a change of management in 20% of patients, in whom a different site for the anastomosis was chosen after ICG-FA.…”

Section: Discussionmentioning

confidence: 99%

The role of fluorescence angiography in colonic interposition after esophagectomy

Joosten

Gisbertz

Heineman

et al. 2022

Diseases of the Esophagus

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Summary Colonic interposition is an alternative for gastric conduit reconstruction after esophagectomy. Anastomotic leakage (AL) occurs in 15–25% of patients and may be attributed to reduced blood supply after vascular ligation. Indocyanine green fluorescence angiography (ICG-FA) can visualize tissue perfusion. We aimed to give an overview of the first experiences of ICG-FA and AL rate in colonic interposition. This study included all consecutive patients who underwent a colonic interposition between January 2015 and December 2021 at a tertiary referral center. Surgery was performed for the following indications: inability to use the stomach because of previous surgery or extensive tumour involvement, cancer recurrence in the gastric conduit, or because of complications after initial esophagectomy. Since 2018 ICG-FA was performed before anastomotic reconstruction by administration of ICG injection (0.1 mg/kg/bolus), using the Spy-phi (Stryker, Kalamazoo, MI). Twenty-eight patients (9 female, mean age 62.8), underwent colonic interposition of whom 15 (54%) underwent ICG-FA-guided surgery. Within the ICG-FA group, three (20%) AL occurred, whereas in the non-ICG-FA group, three AL and one graft necrosis (31%) occurred (P=0.67). There was a change of management due to the FA assessment in three patients in the FA group (20%) which led to the choice of a different bowel segment for the anastomosis. Mean operative times in the ICG-FA and non-ICG-FA groups were 372±99 and 399±113 minutes, respectively (P=0.85). ICG-FA is a safe, easy and feasible technique to assess perfusion of colonic interpositions. ICG-FA is of added value leading to a change in management in a considerable percentage of patients. Its role in prevention of AL remains to be elucidated.

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Section: Discussionmentioning

confidence: 99%