Quantitative perfusion assessment of intestinal anastomoses in pigs treated with glucagon-like peptide 2

Nerup, Nikolaj; Ring, Linea Landgrebe; Strandby, Rune Broni; Egeland, Charlotte; Svendsen, Morten Bo Søndergaard; Hasselby, Jane Preuss; Willemoe, Gro Linno; Hartmann, Bolette; Svendsen, Lars Bo; Achiam, Michael Patrick

doi:10.1007/s00423-018-1718-6

Cited by 12 publications

(10 citation statements)

References 40 publications

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“…Ventilation was paused for 10-20 s after injection of ICG to avoid respiratory movement artifacts during the quantification. For quantification, we used previously validated software (q-ICG) [13][14][15][16][17], and a picture of a color-coded output (beta-version of the present system [20]) representing relative perfusion of the segments (Fig. 1).…”

Section: Perfusion Assessmentmentioning

confidence: 99%

“…Recently, quantitative analysis of ICG-FA (q-ICG) has been introduced to limit the observer bias and reduce reproducibility problems when normal non-quantitative visual ICG-FA is performed. We have previously described our quantification software's validation, reliability, and reproducibility (q-ICG) in a series of animal studies in both normal, increased, and reduced perfusion [13][14][15][16][17].…”

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confidence: 99%

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Quantitative fluorescence angiography aids novice and experienced surgeons in performing intestinal resection in well-perfused tissue

et al. 2021

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Background Anastomotic leakage (AL) after gastrointestinal resection is a devastating complication with huge consequences for the patient. As AL is associated with poor blood supply, tools for objective assessment of perfusion are in high demand. Indocyanine green angiography (ICG-FA) and quantitative analysis of ICG-FA (q-ICG) seem promising. This study aimed to investigate whether ICG-FA and q-ICG could improve perfusion assessment performed by surgeons of different experience levels. Methods Thirteen small bowel segments with a varying degree of devascularization, including two healthy sham segments, were constructed in a porcine model. We recruited students, residents, and surgeons to perform perfusion assessment of the segments in white light (WL), with ICG-FA, and after q-ICG, all blinded to the degree of devascularization. Results Forty-five participants fulfilled the study (18 novices, 12 intermediates, and 15 experienced). ICG and q-ICG helped the novices correctly detect the healthy bowel segments to experienced surgeons’ level. ICG and q-ICG also helped novice surgeons to perform safer resections in healthy tissue compared with normal WL. The relative risk (RR) of leaving ischemic tissue in WL and ICG compared with q-ICG, even for experienced surgeons was substantial, intermediates (RR = 8.9, CI95% [4.0;20] and RR = 6.2, CI95% [2.7;14.1]), and experienced (RR = 4.7, CI95% [2.6;8.7] and RR = 4.0, CI95% [2.1;7.5]). Conclusion Q-ICG seems to guide surgeons, regardless of experience level, to safely perform resection in healthy tissue, compared with standard WL. Future research should focus on this novel tool’s clinical impact.

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Section: Perfusion Assessmentmentioning

confidence: 99%

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confidence: 99%

Quantitative fluorescence angiography aids novice and experienced surgeons in performing intestinal resection in well-perfused tissue

et al. 2021

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“…Seven studies were performed in patients and evaluated perfusion of the gastric conduit during oesophagectomy 21 , 22 , perfusion of free jejunal grafts during pharyngo‐oesophagectomy 23 and perfusion of bowel ends during procedures of the lower gastrointestinal tract. 20 , 24 – 26 The other six studies were animal studies and assessed perfusion in a segment of small bowel or sigmoid in pigs 27 – 31 or stomach perfusion in pigs 32 .…”

Section: Resultsmentioning

confidence: 99%

“…One study 23 observed venous congestion, which was defined as ‘subjectively’ judged unusually slow fluorescence inflow or graft necrosis due to venous thrombosis, which was confirmed during reoperation. Animal studies observed normal organ perfusion 32 , anastomotic healing 27 or ischaemic areas after ligation of supplying vessels 28 – 31 .…”

Section: Resultsmentioning

confidence: 99%

Defining indocyanine green fluorescence to assess anastomotic perfusion during gastrointestinal surgery: systematic review

Slooter¹,

Mansvelders²,

Bloemen

et al. 2021

BJS Open

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Background The aim of this systematic review was to identify all methods to quantify intraoperative fluorescence angiography (FA) of the gastrointestinal anastomosis, and to find potential thresholds to predict patient outcomes, including anastomotic leakage and necrosis. Methods This systematic review adhered to the PRISMA guidelines. A PubMed and Embase literature search was performed. Articles were included when FA with indocyanine green was performed to assess gastrointestinal perfusion in human or animals, and the fluorescence signal was analysed using quantitative parameters. A parameter was defined as quantitative when a diagnostic numeral threshold for patient outcomes could potentially be produced. Results Some 1317 articles were identified, of which 23 were included. Fourteen studies were done in patients and nine in animals. Eight studies applied FA during upper and 15 during lower gastrointestinal surgery. The quantitative parameters were divided into four categories: time to fluorescence (20 studies); contrast-to-background ratio (3); pixel intensity (2); and numeric classification score (2). The first category was subdivided into manually assessed time (7 studies) and software-derived fluorescence–time curves (13). Cut-off values were derived for manually assessed time (speed in gastric conduit wall) and derivatives of the fluorescence–time curves (Fmax, T1/2, TR and slope) to predict patient outcomes. Conclusion Time to fluorescence seems the most promising category for quantitation of FA. Future research might focus on fluorescence–time curves, as many different parameters can be derived and the fluorescence intensity can be bypassed. However, consensus on study set-up, calibration of fluorescence imaging systems, and validation of software programs is mandatory to allow future data comparison.

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“…Several other inflow parameters have been explored following a range of interventions, illustrated by the following examples: (1) A relative-norm-slope parameter could detect a pharmaceutically induced relative increase in anastomotic perfusion following a blinded, randomized, placebocontrolled administration of glucagon-like peptide 2 (GLP-2) in pigs undergoing a small bowel resection (p < 0.05) [47]. (2) A relative-slope parameter was used to identify sites for anastomosis at 30%, 60%, and 100% of relative perfusion.…”

Section: Inflow Parametersmentioning

confidence: 99%

Quantification of fluorescence angiography: Toward a reliable intraoperative assessment of tissue perfusion - A narrative review

Lütken

Achiam

Osterkamp

et al. 2020

Langenbecks Arch Surg

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Background Accurate intraoperative assessments of tissue perfusion are essential in all forms of surgery. As traditional methods of perfusion assessments are not available during minimally invasive surgery, novel methods are required. Here, fluorescence angiography with indocyanine green has shown promising results. However, to secure objective and reproducible assessments, quantification of the fluorescent signal is essential (Q-ICG). This narrative review aims to provide an overview of the current status and applicability of Q-ICG for intraoperative perfusion assessment. Results Both commercial and custom Q-ICG software solutions are available for intraoperative use; however, most studies on Q-ICG have performed post-operative analyses. Q-ICG can be divided into inflow parameters (ttp, t0, slope, and T 1/2 max) and intensity parameters (Fmax, PI, and DR). The intensity parameters appear unreliable in clinical settings. In comparison, inflow parameters, mainly slope, and T 1/2 max have had superior clinical performance. Conclusion Intraoperative Q-ICG is clinically available; however, only feasibility studies have been performed, rendering an excellent usability score. Q-ICG in a post-operative setting could detect changes in perfusion following a range of interventions and reflect clinical endpoints, but only if based on inflow parameters. Thus, future studies should include the methodology outlined in this review, emphasizing the use of inflow parameters (slope or T 1/2 max), a mass-adjusted ICG dosing, and a fixed camera position.

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Quantitative perfusion assessment of intestinal anastomoses in pigs treated with glucagon-like peptide 2

Cited by 12 publications

References 40 publications

Quantitative fluorescence angiography aids novice and experienced surgeons in performing intestinal resection in well-perfused tissue

Quantitative fluorescence angiography aids novice and experienced surgeons in performing intestinal resection in well-perfused tissue

Defining indocyanine green fluorescence to assess anastomotic perfusion during gastrointestinal surgery: systematic review

Quantification of fluorescence angiography: Toward a reliable intraoperative assessment of tissue perfusion - A narrative review

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