Quantitative Assessment of Blood Flow in the Gastric Conduit With Thermal Imaging for Esophageal Reconstruction

Abstract

Objective: The study's primary aim was to evaluate the effectiveness of thermal imaging (TI) and its secondary aim was to compare TI and indocyanine green (ICG) fluorescence angiography, with respect to the evaluation of the viability of the gastric conduit. Summary Background Data: The optimal method for evaluating perfusion in the gastric conduit for esophageal reconstruction has not been established. Methods: We reviewed the prospectively collected data of 263 patients who had undergone esophagectomy with gastric conduit reconstruction. TI was used in all patients. ICG fluorescence was concomitantly used in 24 patients to aid comparison with TI. A cut-off value of the anastomotic viability index (AVI) was calculated using the receiver operating characteristic curve in TI. Results: Anastomotic leak was significantly less common in patients with AVI > 0.61 compared with those with AVI ≤ 0.61 (2% vs 28%, P < 0.001). Microvascular augmentation was performed in 20 patients with a low AVI score and/or preoperative chemoradiotherapy. Overall ability was comparable between TI and ICG fluorescence regarding the qualitative evaluation of the gastric conduit. However, TI was superior in the quantitative assessment of viability. Conclusions: TI could delineate the area of good perfusion in the gastric conduit for esophageal reconstruction, which can help identify patients at high risk of anastomotic leak.

Quantitative serosal and mucosal optical imaging perfusion assessment in gastric conduits for esophageal surgery: an experimental study in enhanced reality

“…However, all of those probe-based optical techniques provide a pin-point perfusion quantification with none or minimal spatial information, and this greatly limits their routine intraoperative use. In this view, technologies with a better spatial resolution, such as laser speckle [ 28 ], fluorescence angiography (FA) [ 6 ], or thermography [ 29 ] have been explored. However, in spite of interesting results, the laser speckle’s perfusion measurement is highly variable in relation to distance and angulation from the target, and the accuracy of this technology has not yet been validated in a controlled experimental setting, using reliable ischemia biomarkers.…”

“…However, this metric is not yet universally accepted and larger trials are necessary to understand its real clinical usefulness. Nishikawa et al [ 29 ] have shown interesting results using thermal imaging during esophagectomies. In particular, the authors proposed a score based on the temperature and on the length of the gastric conduit and its supplying vessels.…”

Comparison of laparoscopic surgery and hand‐assisted laparoscopic surgery in esophagectomy: A propensity score‐matched analysis

“…Both procedures enabled the construction of a carefully designed gastric conduit in which blood flow could be assessed with thermal imaging. They are therefore considered non‐traumatic procedures and may equally protect the stomach against surgical manipulation 20 …”

A case report of a gastrobronchial fistula and lung abscess caused by leakage from the staple line of a gastric tube after esophagectomy for esophageal cancer

“…If we had been concerned about impaired blood flow through the gastric tube, we would have performed the reconstruction using the colon or small intestine. At the time the patient was treated, it was not possible to conduct blood flow assessments using indocyanine green or thermal imaging at our institution [22]. The initial non-surgical treatment almost closed the fistula, but the subsequent restarting of oral intake caused the fistula to worsen.…”