Post esophagectomy anastomotic leakage and stricture are crucial factors in determining morbidity and mortality. Good vascularity of the gastric conduit is essential to avoid this complications. This prospective study assesses the utility of intraoperative indocyanine green (ICG) fluorescence imaging to determine gastric conduit vascularity in patients undergoing esophagectomy. Methods Thirteen consecutive patients who were undergoing esophagectomy for carcinoma middle, lower third esophagus or gastro-esophageal junction from August 2019 to September 2019, were included. Three patients underwent laparoscopic-assisted transhiatal esophagectomy, ten thoraco-laparoscopic assisted esophagectomy. Reconstruction was done by gastric pull up via posterior mediastinal route. Vascularity of gastric conduit was assessed by the near-infrared camera using ICG. Results On visual assessment of perfusion at the tip of gastric conduit, it was dusky in 11 patients, pink in two. Fuorescence imaging showed inadequate perfusion at the tip of conduit in 12 patients, needing revision. In one patient visual inspection showed adequate perfusion, but ICG disclosed poor vascularity requiring revision of the conduit’s tip. Resection of the devitalized portion of the proximal esophageal stump was needed in 5 patients both by visual and ICG assessment. The median time to appearance of blush from the time of injection of dye was 15 seconds (10 to 23 seconds). Conclusion Visual inspection of the gastric conduit vascularity can underestimate perfusion and hence can compromise resection of the devitalized part. ICG fluorescence imaging is more objective and promising means to ascertain the vascularity of gastric conduit during an esophagectomy. It could complement the visual inspection to decide the site of anastomosis.

中文翻译：

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469 通过吲哚菁绿荧光成像在接受食管切除术的患者中评估胃导管和近端食管残端的灌注

食管切除术后吻合口漏和狭窄是决定发病率和死亡率的关键因素。胃导管的良好血管分布对于避免这种并发症至关重要。这项前瞻性研究评估了术中吲哚菁绿 (ICG) 荧光成像在确定接受食管切除术患者胃导管血管分布方面的效用。方法 纳入 2019 年 8 月至 2019 年 9 月连续 13 例因食管中段癌、下 3 段食管癌或胃食管结合部癌行食管切除术的患者。3例患者接受了腹腔镜辅助经食管食管切除术，10例胸腹腔镜辅助食管切除术。重建是通过胃提拉经后纵隔途径完成。通过使用 ICG 的近红外相机评估胃导管的血管状况。结果 目测胃导管末端灌注，11例患者呈暗色，2例呈粉红色。荧光成像显示 12 名患者的导管末端灌注不足，需要修正。在一名患者中，视觉检查显示灌注充足，但 ICG 显示血管分布不良，需要修正导管尖端。通过视觉和 ICG 评估，5 名患者需要切除近端食管残端的失活部分。从注射染料到出现脸红的中位时间为 15 秒（10 至 23 秒）。结论 胃导管血管的目视检查可能会低估灌注，因此可能会影响失活部分的切除。ICG 荧光成像是确定食管切除术期间胃导管血管分布的更客观和有希望的方法。它可以补充目视检查以确定吻合部位。