Near-infrared fluorescence cholangiography with indocyanine green for biliary atresia. Real-time imaging during the Kasai procedure: a pilot study

Abstract

We were able to detect the presence of bile excretion at the time of HPE intraoperatively and successfully evaluated the extent of bile excretion using this new technique. Furthermore, the ICG-FCG findings may provide information leading to a new classification and potentially function as an indicator predicting the clinical outcomes after HPE.

The Use of Indocyanine Green Fluorescence Angiography in Pediatric Surgery: A Systematic Review and Narrative Analysis

“…An important number of included studies ( n = 37; 58%) were at high risk of selection bias as none of them were randomized and allocation of intervention was based on the surgeon's choice. Data collection was mentioned as prospective in only 13/64 studies ( 14 , 22 , 31 , 34 , 44 ). While outcomes were generally appropriate for the study aim, 80% of included studies were at high or unclear risk of information biases either because outcomes were not objectively assessed or blinding of surgeons to the intervention was not possible.…”

“…Other studies either overlooked stating the patient's weight, administration route, or ICG dilution making it difficult to generalize results. Injections were done intraoperatively except for specific indications including surgical procedures for primary ( 70 ) and metastatic ( 16 , 44 , 59 , 64 ) hepatoblastoma and biliary atresia ( 34 ) as well as cholecystectomies ( 22 , 23 , 28 , 31 ) for which ICG was injected from 18 to 72 h before the surgery.…”

“…It has been reported useful for detecting pediatric tumors such as primary hepatoblastoma with or without lung and peritoneal metastases, even more when the surgery is performed by thoracoscopy and tactile sensation is not possible ( 16 , 44 , 59 , 70 ). During Kasai procedures for biliary atresia, indocyanine green was helpful to detect bile leaks which may reduce postoperative morbidity and potentially have an impact on the postoperative normalization of hyperbilirubinemia of the patient ( 34 ). Two studies have also observed the fluorescence in patient's postoperative stools, and although this remains at an experimental stage, they found it useful to evaluate bile excretion ( 34 ) and bowel function ( 69 ).…”

“…During Kasai procedures for biliary atresia, indocyanine green was helpful to detect bile leaks which may reduce postoperative morbidity and potentially have an impact on the postoperative normalization of hyperbilirubinemia of the patient ( 34 ). Two studies have also observed the fluorescence in patient's postoperative stools, and although this remains at an experimental stage, they found it useful to evaluate bile excretion ( 34 ) and bowel function ( 69 ). Assessment of skin flap vascularity in pediatric autologous ear reconstruction with ICG showed a decrease in surgical revisions ( 46 ).…”

Protein enhanced NIR-IIb emission of indocyanine green for functional bioimaging

“…Traditional laparoscopic cholecystectomy (LC) have encountered many problems such as risks of biliary anatomical variations and bile duct injuries [31][32][33] . NIR-I fluorescence imaging with ICG was reported in detecting bile excretion during hepatoportoenterostomy for the treatments of biliary atresia (BA) [34] . A systematic review illustrated that extrahepatic bile duct visualization assisted with ICG NIR-I fluorescence system was superior to intraoperative cholangiogram [35] .…”