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Correlation between indocyanine green visualization time in the gastric tube and postoperative endoscopic assessment of the anastomosis after esophageal surgery

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Abstract

Purpose

To evaluate the correlation between blood supply speed in the gastric tube (GT), assessed by the intraoperative indocyanine green (ICG) fluorescence method, and postoperative endoscopic assessment (PEA) of the anastomosis or anastomotic leakage (AL).

Methods

The subjects of this retrospective analysis were 66 consecutive patients who underwent GT reconstruction using ICG fluorescence during esophageal surgery. We measured the ICG visualization time, from ICG injection to visualization at the top of the GT. We performed PEA on 54 patients and classified ulcer formation as involving less than or more than half of the circumference.

Results

PEA revealed that nine patients (16.7%) had an anastomotic ulcer involving more than half of the circumference and ten (15.4%) had AL. The ICG visualization time in these patients was significantly delayed compared with that in those with less than half of the circumference involved by ulcer formation (37 s vs. 27 s; P = 0.015) and without AL (36 s vs. 28 s; P = 0.045). Multivariate analysis revealed that delay in the ICG visualization time (> 36 s) of the pulled-up GT (odds ratio, 6.098; 95% confidence interval, 1.125–33.024; P = 0.036) was an independent risk factor associated with AL.

Conclusion

Delay in the ICG visualization time of pulled-up GT was associated with ulcer formation on the anastomosis and AL after esophageal surgery.

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Authors and Affiliations

  1. Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku, Kochi, 783-8505, Japan

    Hiroyuki Kitagawa, Tsutomu Namikawa, Jun Iwabu, Keiichiro Yokota, Sunao Uemura, Masaya Munekage & Kazuhiro Hanazaki

Authors
  1. Hiroyuki Kitagawa
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  2. Tsutomu Namikawa
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  3. Jun Iwabu
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  4. Keiichiro Yokota
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  5. Sunao Uemura
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  6. Masaya Munekage
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  7. Kazuhiro Hanazaki
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Correspondence to Tsutomu Namikawa.

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We have no conflicts of interest to declare.

Ethical approval

The study was approved by the Institutional Review Board at the Kochi Medical School (accepted number: ERB-102693) and was undertaken in accordance with the Helsinki declaration and the Japanese Good Clinical Practice Guidelines.

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Informed consent was waived and information on this study was disclosed in the form of opt-out on our hospital website.

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Kitagawa, H., Namikawa, T., Iwabu, J. et al. Correlation between indocyanine green visualization time in the gastric tube and postoperative endoscopic assessment of the anastomosis after esophageal surgery. Surg Today 50, 1375–1382 (2020). https://doi.org/10.1007/s00595-020-02025-3

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  • DOI: https://doi.org/10.1007/s00595-020-02025-3

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