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Laparoscopic Anatomical Hepatectomy Using Takasaki's Approach and Indocyanine Green Fluorescence Navigation
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Minimally invasive assessment of hepatic function in children with indocyanine green elimination: a validation study

Jon Nielsen1, Nikolaj Nerup2, Søren Møller3,4

  • 1a Department of Paediatrics and Adolescent Medicine , Copenhagen University Hospital Rigshospitalet , Copenhagen Ø , Denmark.

Scandinavian Journal of Gastroenterology
|March 30, 2019
PubMed

Insights

A new minimally invasive method using pulse spectrophotometry accurately estimates Indocyanine Green (ICG) elimination in children with liver disease, offering a reliable alternative to blood sampling.

Area of Science:

  • Pediatric Hepatology
  • Diagnostic Technologies
  • Biomedical Engineering

Background:

  • Pediatric liver disease (PLD) presents diverse clinical scenarios, necessitating accurate severity assessment.
  • Current methods for evaluating liver function, like Indocyanine Green (ICG) elimination kinetics, are often invasive, limiting their use in children.
  • There is a clinical need for minimally invasive and reliable tools to assess hepatic function in pediatric patients.

Purpose of the Study:

  • To evaluate the efficacy of a minimally invasive pulse spectrophotometry method (ICGLi) for estimating ICG elimination kinetics in children.
  • To compare ICGLi with the traditional method of serial blood sampling (ICGbs) for measuring ICG elimination.
  • To determine the correlation and agreement between the two methods for assessing liver function in pediatric patients.

Main Methods:

  • One hundred children (aged 0-18 years) with various liver diseases were enrolled.
  • ICG elimination kinetics were measured simultaneously using both ICGLi and ICGbs.
  • Data were analyzed for failure rates, mean difference, limits of agreement, and linear regression to compare plasma disappearance rates (PDRLi and PDRbs).

Main Results:

  • 112 simultaneous measurements were successfully completed in 87 patients.
  • A strong linear correlation (regression coefficient 0.83) was observed between ICGLi and ICGbs.
  • The derived equation PDRbs = 0.83 × PDRLi facilitates conversion between the two methods, despite a systematic difference.

Conclusions:

  • Minimally invasive ICGLi can reliably replace serial blood sampling for ICG elimination assessment in children with PLD.
  • The study identified a systematic relative difference between the methods, suggesting a need for a validated correction factor.
  • Further validation in larger pediatric cohorts is recommended to confirm the utility of ICGLi and the proposed correction.

Keywords:
Pediatric liver diseaseautoimmune hepatitisbiliary atresiaindocyanine greenliver function testsliver transplantation

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