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Quantitative fluorescence angiography detects dynamic changes in gastric perfusion

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Abstract

Introduction

The use of Indocyanine green (ICG) fluorescence angiography (ICG-FA) is an applied method to assess visceral perfusion during surgical procedures worldwide. Further development has entailed quantification of the fluorescence signal; however, whether quantified ICG-FA can detect intraoperative changes in perfusion after hemorrhage has not been investigated previously. In this study, we investigated whether a quantification method, developed and validated in our department (q-ICG), could detect changes in gastric perfusion induced by hemorrhage and resuscitation.

Methods

Ten pigs were included in the study. Specific regions of interest of the stomach were chosen, and three q-ICG measurements of gastric perfusion obtained: 20 min after completion of the laparoscopic setup (baseline), after reducing the circulating blood volume by 30%, and after reinfusion of the withdrawn blood volume. Hemodynamic variables were recorded, and blood samples were collected every 10 min during the procedure.

Results

The reduction in blood volume generated decreased gastric perfusion (q-ICG) from baseline (p = 0.023), and gastric perfusion subsequently increased (p < 0.001) after the reintroduction of the withdrawn blood volume. Cardiac output (CO) and mean arterial blood pressure (MAP) shifted correspondingly and the gastric perfusion correlated to CO (r = 0.575, p = 0.001) and MAP (r = 0.436, p = 0.018).

Conclusion

We present a novel study showing that the q-ICG method can detect dynamic changes in local tissue perfusion induced by hemorrhage and resuscitation. As regional gastrointestinal perfusion may be significantly reduced, while hemodynamic variables such as MAP or heart rate remain stable, q-ICG may provide an objective, non-invasive method for detecting regional early ischemia, strengthening surgical decision making.

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Acknowledgements

We thank Anders Bech Jørgensen, Andreas Arendtsen Rostved, Karina Adler Riemenschneider Mikkel Marquard Jessen, August Olsen, Olivia Mortensen and Søren Roepstorff (Department of Surgical Gastroenterology, Rigshospitalet, University Hospital of Copenhagen) for their excellent operative assistance.

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Authors and Affiliations

  1. Department of Surgical Gastroenterology, Rigshospitalet, University Hospital of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark

    Jens Osterkamp, Rune Strandby, Nikolaj Nerup, Lars Svendsen & Michael Achiam

  2. Copenhagen Academy of Medical Education and Simulation, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Morten Svendsen

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  1. Jens Osterkamp
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  2. Rune Strandby
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Correspondence to Jens Osterkamp.

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Jens Osterkamp, Rune Strandby, Nikolaj Nerup, Morten Bo Søndergaard Svendsen, Lars Svendsen, Michael P. Achiam have no conflicts of interest or financial ties to disclose.

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Osterkamp, J., Strandby, R., Nerup, N. et al. Quantitative fluorescence angiography detects dynamic changes in gastric perfusion. Surg Endosc 35, 6786–6795 (2021). https://doi.org/10.1007/s00464-020-08183-2

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