A quantitative assessment of perfusion of the gastric conduit after oesophagectomy using near-infrared fluorescence with indocyanine green

Galema, Hidde A.; Faber, Robin A.; Tange, Floris; Hilling, Denise E.; Vorst, Joost R. van der

doi:10.1016/j.ejso.2023.02.017

Cited by 7 publications

(1 citation statement)

References 19 publications

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“…However, a range of Q-ICG parameters have shown to correlate to clinical outcomes in previous reports, ranging from a pragmatic cutoff value for time until fluorescence enhancement to more specific parameters as the (normalized) maximum slope, , or time until maximum enhancement [ 12 , 14 , 30 – 32 ]. Interestingly, one study distinguished three distinct perfusion patterns rather than focusing on single or combined Q-ICG parameters in a similar study population of patients undergoing an esophagostomy with gastric conduit reconstruction [ 33 ]. In that study, groups were too small to determine how these perfusion patterns related to clinical endpoints.…”

Section: Discussionmentioning

confidence: 99%

Quantification of fluorescence angiography for visceral perfusion assessment: measuring agreement between two software algorithms

Nijssen,

Joosten,

Osterkamp

et al. 2024

Surg Endosc

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Background Indocyanine green fluorescence angiography (ICG-FA) may reduce perfusion-related complications of gastrointestinal anastomosis. Software implementations for quantifying ICG-FA are emerging to overcome a subjective interpretation of the technology. Comparison between quantification algorithms is needed to judge its external validity. This study aimed to measure the agreement for visceral perfusion assessment between two independently developed quantification software implementations. Methods This retrospective cohort analysis included standardized ICG-FA video recordings of patients who underwent esophagectomy with gastric conduit reconstruction between August 2020 until February 2022. Recordings were analyzed by two quantification software implementations: AMS and CPH. The quantitative parameter used to measure visceral perfusion was the normalized maximum slope derived from fluorescence time curves. The agreement between AMS and CPH was evaluated in a Bland–Altman analysis. The relation between the intraoperative measurement of perfusion and the incidence of anastomotic leakage was determined for both software implementations. Results Seventy pre-anastomosis ICG-FA recordings were included in the study. The Bland–Altman analysis indicated a mean relative difference of + 58.2% in the measurement of the normalized maximum slope when comparing the AMS software to CPH. The agreement between AMS and CPH deteriorated as the magnitude of the measured values increased, revealing a proportional (linear) bias (R2 = 0.512, p < 0.001). Neither the AMS nor the CPH measurements of the normalized maximum slope held a significant relationship with the occurrence of anastomotic leakage (median of 0.081 versus 0.074, p = 0.32 and 0.041 vs 0.042, p = 0.51, respectively). Conclusion This is the first study to demonstrate technical differences in software implementations that can lead to discrepancies in ICG-FA quantification in human clinical cases. The possible variation among software-based quantification methods should be considered when interpreting studies that report quantitative ICG-FA parameters and derived thresholds, as there may be a limited external validity.

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Section: Discussionmentioning

confidence: 99%

Quantification of fluorescence angiography for visceral perfusion assessment: measuring agreement between two software algorithms

Nijssen,

Joosten,

Osterkamp

et al. 2024

Surg Endosc

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Quantification of indocyanine green near-infrared fluorescence bowel perfusion assessment in colorectal surgery

et al. 2023

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Background Indocyanine green near-infrared fluorescence bowel perfusion assessment has shown its potential benefit in preventing anastomotic leakage. However, the surgeon's subjective visual interpretation of the fluorescence signal limits the validity and reproducibility of the technique. Therefore, this study aimed to identify objective quantified bowel perfusion patterns in patients undergoing colorectal surgery using a standardized imaging protocol. Method A standardized fluorescence video was recorded. Postoperatively, the fluorescence videos were quantified by drawing contiguous region of interests (ROIs) on the bowel. For each ROI, a time-intensity curve was plotted from which perfusion parameters (n = 10) were derived and analyzed. Furthermore, the inter-observer agreement of the surgeon’s subjective interpretation of the fluorescence signal was assessed. Results Twenty patients who underwent colorectal surgery were included in the study. Based on the quantified time-intensity curves, three different perfusion patterns were identified. Similar for both the ileum and colon, perfusion pattern 1 had a steep inflow that reached its peak fluorescence intensity rapidly, followed by a steep outflow. Perfusion pattern 2 had a relatively flat outflow slope immediately followed by its plateau phase. Perfusion pattern 3 only reached its peak fluorescence intensity after 3 min with a slow inflow gradient preceding it. The inter-observer agreement was poor-moderate (Intraclass Correlation Coefficient (ICC): 0.378, 95% CI 0.210–0.579). Conclusion This study showed that quantification of bowel perfusion is a feasible method to differentiate between different perfusion patterns. In addition, the poor-moderate inter-observer agreement of the subjective interpretation of the fluorescence signal between surgeons emphasizes the need for objective quantification.

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Dye-less quantification of tissue perfusion by laser speckle contrast imaging is equivalent to quantified indocyanine green in a porcine model

Skinner,

Marois,

Oberlin

et al. 2024

Surg Endosc

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A quantitative assessment of perfusion of the gastric conduit after oesophagectomy using near-infrared fluorescence with indocyanine green

Cited by 7 publications

References 19 publications

Quantification of fluorescence angiography for visceral perfusion assessment: measuring agreement between two software algorithms

Quantification of fluorescence angiography for visceral perfusion assessment: measuring agreement between two software algorithms

Quantification of indocyanine green near-infrared fluorescence bowel perfusion assessment in colorectal surgery

Dye-less quantification of tissue perfusion by laser speckle contrast imaging is equivalent to quantified indocyanine green in a porcine model

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