title: Hemodynamics of the reconstructed gastric tube during esophagectomy: assessment of outcomes with indocyanine green fluorescence.
abstract: BACKGROUND
  Construction of a gastric tube that is well perfused with blood during esophagectomy is the most important factor in avoiding anastomotic leakage. We clarified the hemodynamics of the reconstructed gastric tube with indocyanine green (ICG) fluorescence.
  
  
  METHODS
  In 20 patients undergoing gastric tube reconstruction during esophagectomy, we evaluated blood flow in the gastric tube with ICG fluorescence imaging. We divided the patients into two groups according to the quality of blood flow to the gastric tube-"good" (n = 9) and "sparse or absent" (n = 11)-based on visual assessment of the anastomosis of the right and left gastroepiploic vessels. We measured the time from initial enhancement of the root of the right gastroepiploic artery until enhancement of the most cranial branch of the left gastroepiploic artery and tip of the gastric tube.
  
  
  RESULTS
  The gastric tube was divisible into three zones according to the dominant arteries present in the greater curvature under ICG fluorescence. The left gastroepiploic artery was enhanced in a direction opposite that of physiological blood flow in all cases. The median period from initial enhancement of the root of the right gastroepiploic artery to the most cranial branch of the left gastroepiploic artery until perfusion up to the tip of the gastric tube did not differ significantly between the "good" and the "sparse or absent" groups (P = 0.24, 0.68) CONCLUSIONS: It is essential to preserve the whole vessel arcade of the greater curvature to achieve good blood perfusion in the gastric tube. The ICG fluorescence method has potential usefulness for evaluation of blood flow in the gastric tube.
authors.affiliation: Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan, kuma7srg1@gmail.com.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kumagai
authors.forename: Toru
authors.initials: T
authors.lastname: Ishiguro
authors.forename: Norihiro
authors.initials: N
authors.lastname: Haga
authors.forename: Koki
authors.initials: K
authors.lastname: Kuwabara
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Kawano
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ishida
mesh_terms: D000368:Aged; D004396:Coloring Agents; D013505:Digestive System Surgical Procedures / Q000379:methods; D016629:Esophagectomy; D005260:Female; D005453:Fluorescence; D006439:Hemodynamics; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012039:Regional Blood Flow; D012307:Risk Factors; D013270:Stomach / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green