Abstract Background Inadequate blood supply to the gastric conduit tip during esophagectomy can lead to anastomotic leak. While clinical assessment remains the standard method for assessing gastric conduit vascularity, its reliability may be limited by subjectivity. Indocyanine green (ICG) fluorescence imaging has emerged as a promising alternative for objective and real-time vascularity assessment. The primary outcome is to evaluate the accuracy of intraoperative gastric conduit vascularity assessment using indocyanine green (ICG) fluorescence imaging compared to clinical inspection, with a focus on the difference in gastric conduit tip perfusion and concordance between the two methods. Methods A retrospective single institute cohort study was conducted with 99 patients who had undergone esophagectomy with gastric conduit reconstruction. After preparing gastric conduit, intraoperative vascularity assessment was performed by clinical inspection (colour of conduit tip, pulsations and bleeding from cut edge) and mark the transection line. Reconstituted ICG dye was injected intravenous and check for the green enhanced conduit within 60 seconds. Demarcation between vascularised and non-vascularised segment was marked. The difference in perfusion of the gastric conduit tip transection point as assessed clinically vs fluorescence marking was recorded. Results The mean difference in transection line of gastric conduit tip perfusion between ICG and clinical inspection was 1.25 cm (Coefficient correlation 0.88), indicating a more precise detection of vascularity using ICG. Concordance between ICG and clinical inspection was found to be 74.4%. Conclusion Intraoperative vascularity assessment using ICG fluorescence imaging is more accurate and reliable than clinical inspection in identifying gastric conduit perfusion, with implications for reducing postoperative anastomotic leak. Further studies with larger cohorts are recommended to confirm these findings and assess long-term outcomes.
Jethani et al. (Fri,) studied this question.