Evaluation of Gastric Conduit Perfusion During Esophagectomy with Indocyanine Green Fluorescence Imaging

Background: Anastomotic leakage is a determining factor of morbidity and mortality after an esophagectomy. An adequate blood supply of the gastric conduit is vital to prevent this complication. We aimed to determine the feasibility and usefulness of indocyanine green (ICG) fluorescence imaging to evaluate the gastric conduit perfusion during an esophagectomy. Methods: Patients with distal esophageal cancer or esophagogastric junction cancer scheduled for esophagectomy were enrolled in this study. After pulling up the gastric conduit into the chest and before performing the anastomosis, 5mg of ICG was injected as a bolus. Visual assessment of the blood supply of the gastric conduit was compared with the ICG fluorescence imaging pattern of perfusion. Results: Five patients were included in this study. Hybrid Ivor Lewis esophagectomy (laparoscopic abdomen and right thoracotomy) was performed in all cases. In all patients, visual assessment of the perfusion of the stomach determined that the conduit was well perfused. In two patients (40%), ICG fluorescence showed an inadequate blood supply of the conduit's tip. Resection of the devitalized portion of the conduit was performed in these two patients. No anastomotic leaks were recorded, and all patients had an uneventful postoperative course. Conclusions: Visual assessment of the gastric conduit may underestimate perfusion and inadequate blood supply. ICG fluorescence imaging is a promising tool to determine the gastric conduit perfusion during an esophagectomy. Prospective studies with larger series are warranted to confirm the usefulness of ICG fluorescence imaging during an esophagectomy.