Qualitative features of esophageal fluorescence angiography and anastomotic outcomes in children

Meisner, Jay; Kamran, Ali; Staffa, Steven J.; Mohammed, Somala; Yasuda, Jessica L.; Ngo, Peter; Manfredi, Michael A.; Zurakowski, David; Jennings, Russell W.; Hamilton, Thomas E.; Zendejas, Benjamin

doi:10.1016/j.jpedsurg.2022.07.007

Cited by 5 publications

(3 citation statements)

References 47 publications

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“…thoracoscopic anastomosis, and combined them with tissue quality and anastomotic tension into an Esophageal Anastomotic Perfusion (EAP) score in order to stratify with a high degree of accuracy the risk of a poor anastomotic outcome (defined as any anastomosis with either an anastomotic leak or development of a refractory anastomotic stricture) (11). During thoracoscopy, intravenous ICG was administered and qualitative perfusion features were determined by the surgeons, although the authors did not specify the dose administered.…”

Section: Meisner Et Al Identified Qualitative Nirf Icg Perfusion Feat...mentioning

confidence: 99%

“…Although the clearance rate decreases subsequently, it is cleared quickly enough to allow multiple injections in most procedures. Despite a paucity of clinical studies evaluating its role in esophagogastric pediatric surgery, FGS has shown promising results in helping guide TEF (13) or thoracic duct identification (15) and improving the accuracy of anatomical delineation in EA repair procedure (11) and redo funduplication surgery (16). The administration of ICG sprayed through the trachea into the fistulae, which had not been previously described, allowed the identification of recurrent TEFs eliminating the need for guide wire placement, which can save anesthesia time and reduce tissue damage (13).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…10 Meisner et al identified qualitative NIRF ICG perfusion features of 55 esophageal thoracoscopic anastomosis, and combined them with tissue quality and anastomotic tension into an esophageal anastomotic perfusion (EAP) score in order to stratify with a high degree of accuracy the risk of a poor anastomotic outcome (defined as any anastomosis with either an anastomotic leak or development of a refractory anastomotic stricture). 11 During thoracoscopy, intravenous ICG was administered and qualitative perfusion features were determined by the surgeons, although the authors did not specify the dose administered. Presence of segmental or global areas of hypoperfusion, lack of vessel arborization on both segments, and suture line hypoperfusion width more than twice the expected were the qualitative EAP features associated on univariate analysis with poor anastomotic outcome.…”

Section: Esophagogastric Surgerymentioning

confidence: 99%

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The Role of Indocyanine Green in Pediatric Gastrointestinal Surgery: Systematic Review

2023

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Introduction: The use of near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) is actually considered as a very useful tool in decision-making strategy during challenging surgical procedures with a growing evidence in the literature. Our aim is to perform a systematic review focusing on ICG applications in gastrointestinal surgery. Methods: We conducted a systematic review with narrative synthesis in conformity with the PRISMA guidelines using PubMed, Medline, and EMBASE databases to identify articles describing the gastrointestinal perioperative use of ICG in children. We extracted data on study design, demographics, surgical indications, indocyanine green dose, and perioperative outcomes. Results: Eleven articles, including 94 pediatric patients, from 2013 to 2022 met the inclusion criteria for narrative synthesis in our systematic review, of which 6/11 (54.5%) were case reports, 4/11 (36.4%) were retrospective studies and 1/11 (0.1%) were case series. Current clinical applications of ICG in gastrointestinal pediatric surgery included: esophagogastric surgery in 4/11 articles (36.4%), intestinal and pancreatic surgery in 3/11 articles (27.2%) and colorrectal surgery in 4/11 articles (36.4%). Conclusions: ICG fluorescence in gastrointestinal pediatric surgery is a promising and safe technology that facilitates intraoperative localization of anatomical structures to achieve a more precise dissection and avoid injury to other adjacent tissues. It can be considered as a meaningful tool for assessing intestinal viability, as it provides objective data on tissue perfusion, and can impact the intraoperative decision in reconstructive surgeries requiring anastomosis. Future studies are needed to confirm these initial promising results. The lack of comparative and prospective studies is still the main limitation.

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Section: Meisner Et Al Identified Qualitative Nirf Icg Perfusion Feat...mentioning

confidence: 99%