Real-time bowel perfusion monitoring with FUJIFILM ELUXEO® VISION endoscopic imaging system in colorectal surgery

Anastomotic leak is a serious complication of bowel anastomosis, with multifactorial etiology. Thorough intraoperative evaluation of the anastomosis using white light endoscopy and leak tests is critical. Indocyanine green fluorescence angiography (ICG-FA) has emerged as a tool to assess bowel perfusion, but has limitations, including patient allergies and procedural complexity. The FUJIFILM ELUXEO® VISION Endoscopic Imaging System uses oxygen saturation imaging (OSI) to measure tissue oxygen saturation (StO₂) in real time, without requiring dye injection. This study investigates a novel quantitative approach for assessing bowel perfusion endoscopically by evaluating StO₂ at colon anastomoses.

The FUJIFILM VISION was used to obtain intraoperative mucosal StO₂ measurements in 12 patients' post-colon resection with anastomosis. Measurements were taken at four locations: proximal base, proximal staple line, distal staple line, and distal base. Two-tailed paired t tests were used to compare StO₂ measurements at distant healthy mucosa (base) to the staple line, both proximal and distal to the anastomosis. Patients were followed longitudinally via chart review to monitor outcomes.

The average StO₂ differences were + 12.58% (95% CI 1.96 - 23.19%) between the proximal base and proximal staple line and + 15.34% (95% CI 6.76 - 23.9%) between the distal base and distal staple line. Significant StO₂ differences were observed between baseline normal mucosa and staple line adjacent mucosa (proximal: p = 0.025; distal: p = 0.003). No patients had intraoperative complications or developed anastomotic leaks during the study.

This study shows that the ELUXEO® VISION Endoscopic Imaging System is a potentially useful tool for providing quantitative data on tissue perfusion at and near anastomotic sites, complementing traditional white light endoscopy and leak tests. Larger prospective studies with long-term follow-up are needed to confirm the relationship between StO₂ measurements and clinical outcomes such as anastomotic leaks and stricture.