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Quantitative perfusion assessment of intestinal anastomoses in pigs treated with glucagon-like peptide 2

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Abstract

Purpose

Despite exhaustive research and improvement of techniques, anastomotic leakage remains a frequent complication in gastrointestinal surgery. As leakage is associated with poor perfusion, reliable objective methods to assess anastomotic perfusion are highly demanded. In addition, such methods enable evaluation of interventions that may improve anastomotic perfusion. Glucagon-like peptide 2 (GLP-2) is an enteroendocrine hormone that regulates mid-gut perfusion. In the present study, we aimed to explore if quantitative perfusion assessment with indocyanine green (q-ICG) could detect an increase in porcine anastomotic perfusion after treatment with GLP-2.

Methods

Nineteen pigs had two small bowel resections followed by anastomosis. Blinded to all investigators, animals were randomized to receive GLP-2 or placebo. Anastomotic perfusion was assessed at baseline, 30 min after injection of GLP-2/placebo, and after 5 days of treatment. Anastomotic strength and healing were evaluated by bursting pressure and histology.

Results

Q-ICG detected a significantly higher increase in anastomotic perfusion (p < 0.05) in animals treated with GLP-2, compared with placebo. No significant differences in anastomotic strength or healing were found.

Conclusions

Q-ICG is a promising tool for perfusion assessment in gastrointestinal surgery and opens new opportunities in research of factors that may influence anastomotic healing, but further research is warranted to evaluate the effects of GLP-2 on anastomotic healing.

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Acknowledgments

Authors sincerely thank Lars Thim, Ph.D., DMSci, Novo Nordisk, Denmark for providing the GLP-2 analog (NNCD 0103-0000-0066). Furthermore, we thank Professor Palle Bekker Jeppesen, Ph.D., DMSci, Department of Medical Gastroenterology, Rigshospitalet, Denmark for invaluable advice during the study design.

Funding

The study was sponsored by donations from private foundations: Mogens Andresen fonden, Civilingeniør Johannes Elmqvist Ormstrup og Hustru Grete Omstrups Fond, and Fabrikant Frands Køhler Nielsens og Hustrus Mindelegat. Sponsors had no role in study design, interpretation of results or any other part of the study.

Author information

Authors and Affiliations

  1. Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark

    Nikolaj Nerup, Linea Landgrebe Ring, Rune Broni Strandby, Charlotte Egeland, Lars Bo Svendsen & Michael Patrick Achiam

  2. Copenhagen Academy of Medical Education and Simulation, Copenhagen, Capital Region of Denmark, Denmark

    Morten Bo Søndergaard Svendsen

  3. Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

    Jane Preuss Hasselby & Gro Linno Willemoe

  4. Section for Translational Metabolic Physiology, Faculty of Health, Copenhagen University, Copenhagen, Denmark

    Bolette Hartmann

Authors
  1. Nikolaj Nerup
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  2. Linea Landgrebe Ring
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Contributions

• Study conception and design: NN, LBS, MPA.

• Acquisition of data: NN, LLR, RBS, CE, MBS, JP, GLW, BH, LBS, MPA.

• Analysis and interpretation of data: NN, MBS, JP, GLW, BH, LBS, MPA.

• Drafting of the manuscript: NN.

• Critical revision and final approval of the manuscript: NN, LLR, RBS, CE, MBS, JP, GLW, BH, LBS, MPA.

Corresponding author

Correspondence to Nikolaj Nerup.

Ethics declarations

The study followed the Danish and European Union legislation on animal experimentation and was approved by the Danish Animal Experimentation Council (#2016-15-0201-01015).

Ethical approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted.

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Nerup, N., Ring, L.L., Strandby, R.B. et al. Quantitative perfusion assessment of intestinal anastomoses in pigs treated with glucagon-like peptide 2. Langenbecks Arch Surg 403, 881–889 (2018). https://doi.org/10.1007/s00423-018-1718-6

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  • DOI: https://doi.org/10.1007/s00423-018-1718-6

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