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Quantitative fluorescence angiography detects dynamic changes in gastric perfusion.

Jens Osterkamp1, Rune Strandby2, Nikolaj Nerup2

  • 1Department of Surgical Gastroenterology, Rigshospitalet, University Hospital of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark. jens.thomas.fredrik.osterkamp.02@regionh.dk.

Surgical Endoscopy
|December 1, 2020
PubMed
Summary

Quantified Indocyanine green fluorescence angiography (q-ICG) effectively detects changes in gastric perfusion during hemorrhage and resuscitation. This method offers objective insights into early ischemia, aiding surgical decisions.

Keywords:
Fluorescence angiographyGastric perfusionIndocyanine greenQuantification

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Area of Science:

  • Surgical Innovation
  • Medical Imaging
  • Physiology

Background:

  • Indocyanine green fluorescence angiography (ICG-FA) is globally used to evaluate visceral perfusion during surgery.
  • Quantification of ICG-FA signals is an emerging area, but its ability to detect perfusion changes post-hemorrhage is unproven.

Purpose of the Study:

  • To investigate if a validated quantification method (q-ICG) can detect alterations in gastric perfusion caused by hemorrhage and resuscitation.
  • To assess the utility of q-ICG in identifying intraoperative perfusion deficits.

Main Methods:

  • Ten pigs underwent procedures involving induced hemorrhage (30% blood volume reduction) and subsequent resuscitation.
  • Gastric perfusion was measured using q-ICG at baseline, after hemorrhage, and after reinfusion.
  • Hemodynamic variables and blood samples were monitored throughout the study.

Main Results:

  • Gastric perfusion significantly decreased after hemorrhage (p=0.023) and increased upon reinfusion (p<0.001).
  • Cardiac output and mean arterial blood pressure changes correlated with gastric perfusion.
  • Gastric perfusion showed significant correlation with cardiac output (r=0.575, p=0.001) and MAP (r=0.436, p=0.018).

Conclusions:

  • The q-ICG method successfully detects dynamic changes in local tissue perfusion during hemorrhage and resuscitation.
  • q-ICG provides an objective, non-invasive tool for early ischemia detection, potentially improving surgical decision-making.
  • This technique may reveal significant gastrointestinal perfusion reductions even when systemic hemodynamics appear stable.