Fluorescence-Guided Surgery With Indocyanine Green in Acute Bowel Ischemia: A Systematic Review

The systematic review evaluates the impact of indocyanine green fluorescence angiography (ICG-FA) on surgical decisions, postoperative complications, and mortality in acute bowel ischemia.

Studies were included if they met the following criteria: patients ≥18 y undergoing ICG-FA for perfusion assessment in all-cause acute bowel ischemia; if they were human clinical studies with original data (n ≥ 5); and if they were published in English, Latin, or Nordic languages. The primary outcome was change of strategy; secondary outcomes included postoperative complications and mortality. Studies were excluded if they were reviews or meta-analyses, animal studies, or papers without original empirical data. Risk of bias was assessed with the Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I Tool). Outcomes were presented narratively, given the high clinical and methodological heterogeneity across studies.

Seven studies met the following inclusion criteria: five retrospective cohort studies and two case series. No randomized trials were identified. A total of 356 patients undergoing fluorescence-guided surgery for suspected or confirmed acute bowel ischemia were included. Across studies, the reported change in surgical strategy ranged from 29% to 67%, postoperative complications from 0% to 24%, and mortality from 0% to 64%.

Our findings suggest that ICG-FA may influence surgical decision-making in acute bowel ischemia by guiding resection strategy, but no clinical benefit in regard to postoperative outcomes was shown. However, the evidence is limited to small, retrospective studies with significant risk of bias and low quality of evidence.