Endoscopic Congo red test during proximal gastric vagotomy

Area of Science:

• Gastroenterology
• Surgical Innovation

Background:

• Proximal gastric vagotomy is a common treatment for duodenal ulcers.
• Recurrent ulcers after this procedure remain a significant clinical challenge.

Purpose of the Study:

• To introduce and evaluate the endoscopic Congo red test for intraoperative assessment of vagotomy completeness.
• To determine if the test can identify intact vagal nerve pathways and guide surgical technique.

Main Methods:

• The endoscopic Congo red test was used during proximal gastric vagotomy procedures.
• The test maps areas with intact vagus and secretory nerves, allowing for verification of vagotomy completion.

Main Results:

• The endoscopic Congo red test accurately identifies residual vagal innervation.
• Physiologic evidence suggests vagus nerve fibers travel through gastroepiploic nerves, supporting their routine division.
• The test can be used intraoperatively and postoperatively, and preoperatively in reoperation cases.

Conclusions:

• The endoscopic Congo red test is a valuable tool for ensuring complete vagotomy during surgery for duodenal ulcers.
• Routine division of gastroepiploic nerves is recommended based on test findings.
• Further investigation and wider application of this test are warranted.