title: Metabolism-Guided Bowel Resection: Potential Role and Accuracy of Instant Capillary Lactates to Identify the Optimal Resection Site.
abstract: BACKGROUND
  Strip-based handheld devices can measure lactatemia on capillary blood obtained by needle puncturing. We aimed to assess the kinetic of bowel capillary lactates, metabolomics profiling, and mitochondria respiratory rate in a prolonged model of bowel hypoperfusion.
  
  
  METHODS
  In 6 pigs, a 3- to 4-cm ischemic segment was created in 6 small bowel loops (total = 36 loops) by clamping the vascular supply, for a duration of 1 to 6 hours. Hourly, 5 blood samples were obtained by puncturing the serosa, and lactates were measured using a handheld analyzer. Samples were made at the following regions of interest (ROIs): center of the ischemic area (1), proximal and distal clinical margins of resection (2a-2b), and vascularized zones (3a-3b). Every hour, surgical biopsies of ROIs were sampled. Activity of bowel mitochondria complexes was measured after 1, 3, and 5 hours of ischemia. Quantification of metabolites was performed on all samples (total N = 180).
  
  
  RESULTS
  Capillary lactates were significantly higher at ROI 1 versus ROI 3ab at all time points. After 1 hour lactates at the margins were significantly higher than those at vascularized areas (P = .0095), showing a mismatch between visual assessment and actual perfusion status. From 2 to 6 hours, there was no difference in lactates between ROIs 2a-2b and 3a-3b. Maximal tissue respiration decreased significantly after 1 hour (ROI 1 vs ROI 3ab). Seven metabolites (lactate, glucose, aspartate, choline, creatine, taurine, and tyrosine) expressed significantly different evolutions between ROIs.
  
  
  CONCLUSIONS
  Capillary lactates could help precisely estimate local bowel perfusion status.
authors.affiliation: IRCAD Institute for Research Against Cancer of the Digestive System, Strasbourg, France IHU-Strasbourg, University Institute for Image-Guided Surgery, Strasbourg, France University of Strasbourg, Strasbourg, France michele.diana@ircad.fr.
authors.forename: Michele
authors.initials: M
authors.lastname: Diana
authors.affiliation: Department of Anesthesiology, University of Strasbourg, Strasbourg, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Noll
authors.affiliation: Department of Anesthesiology, University of Strasbourg, Strasbourg, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Diemunsch
authors.affiliation: Biophisics and Nuclear Medicine Department, University of Strasbourg, Strasbourg, France.
authors.forename: François-Marie
authors.initials: FM
authors.lastname: Moussallieh
authors.affiliation: Biophisics and Nuclear Medicine Department, University of Strasbourg, Strasbourg, France.
authors.forename: Izzie-Jacques
authors.initials: IJ
authors.lastname: Namer
authors.affiliation: Physiology Institute, EA3072 Mitochondria and Oxidative Stress, University of Strasbourg, Strasbourg, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Charles
authors.affiliation: Department of Pathology, University of Strasbourg, Strasbourg, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Lindner
authors.affiliation: IRCAD Institute for Research Against Cancer of the Digestive System, Strasbourg, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Agnus
authors.affiliation: Physiology Institute, EA3072 Mitochondria and Oxidative Stress, University of Strasbourg, Strasbourg, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Geny
authors.affiliation: IRCAD Institute for Research Against Cancer of the Digestive System, Strasbourg, France IHU-Strasbourg, University Institute for Image-Guided Surgery, Strasbourg, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D000818:Animals; D001706:Biopsy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D007421:Intestine, Small / Q000737:chemistry / Q000293:injuries* / Q000378:metabolism / Q000601:surgery*; D007511:Ischemia / Q000378:metabolism; D007773:Lactates / Q000097:blood* / Q000378:metabolism; D055432:Metabolomics / Q000379:methods*; D013552:Swine
chemical_list: D007773:Lactates
keywords: bowel hypoperfusion; capillary lactates; magnetic resonance spectroscopy; metabolomics profiling; oxygraphic mitochondria respiratory rate