title: Near-infrared fluorescence cholangiography with indocyanine green for biliary atresia. Real-time imaging during the Kasai procedure: a pilot study.
abstract: BACKGROUND
  Hepatoportoenterostomy (HPE) with the Kasai procedure is the treatment of choice for biliary atresia (BA) as the initial surgery. However, the appropriate level of dissection level of the fibrous cone (FC) of the porta hepatis (PH) is frequently unclear, and the procedure sometimes results in unsuccessful outcomes. Recently, indocyanine green near-infrared fluorescence imaging (ICG-FCG) has been developed as a form of real-time cholangiography.
  
  
  METHODS
  We applied this technique in five patients with BA to visualize the biliary flow at the PH intraoperatively. ICG was injected intravenously the day before surgery as the liver function test, and the liver was observed with a near-infrared camera system during the operation while the patient's feces was also observed.
  
  
  RESULTS
  In all patients, the whole liver fluoresced diffusely with ICG-containing stagnant bile, whereas no extrahepatic structures fluoresced. The findings of the ICG fluorescence pattern of the PH after dissection of the FC were classified into three types: spotty fluorescence, one patient; diffuse weak fluorescence, three patients; and diffuse strong fluorescence, one patient. In all five patients, the feces evacuated after HPE showed distinct fluorescent spots, although that obtained before surgery showed no fluorescence. One patient with diffuse strong fluorescence who did not achieve JF underwent living related liver transplantation six months after the initial HPE procedure. Four patients, including three cases involving diffuse weak fluorescence and one case involving spotty fluorescence showed weak fluorescence compared to that of the surrounding liver surface.
  
  
  CONCLUSIONS
  We were able to detect the presence of bile excretion at the time of HPE intraoperatively and successfully evaluated the extent of bile excretion using this new technique. Furthermore, the ICG-FCG findings may provide information leading to a new classification and potentially function as an indicator predicting the clinical outcomes after HPE.
authors.affiliation: Department of Pediatric Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, Niigata, 950-1197, Japan. you4141@aol.com.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hirayama
authors.affiliation: Department of Pediatric Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, Niigata, 950-1197, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iinuma
authors.affiliation: Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, Niigata, 950-1197, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Yokoyama
authors.affiliation: Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, Niigata, 950-1197, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Otani
authors.affiliation: Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Masui
authors.affiliation: Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Komatsuzaki
authors.affiliation: Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Naruki
authors.initials: N
authors.lastname: Higashidate
authors.affiliation: Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Shiori
authors.initials: S
authors.lastname: Tsuruhisa
authors.affiliation: Department of Pediatric Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, Niigata, 950-1197, Japan.
authors.forename: Hisataka
authors.initials: H
authors.lastname: Iida
authors.affiliation: Department of Pediatric Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, Niigata, 950-1197, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Nakaya
authors.affiliation: Department of Pediatric Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, Niigata, 950-1197, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Naito
authors.affiliation: Department of Pediatric Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, Niigata, 950-1197, Japan.
authors.forename: Koju
authors.initials: K
authors.lastname: Nitta
authors.affiliation: Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Yagi
mesh_terms: D001652:Bile Ducts / Q000601:surgery; D001656:Biliary Atresia / Q000601:surgery*; D002758:Cholangiography; D004396:Coloring Agents; D005260:Female; D005453:Fluorescence; D006801:Humans; D007208:Indocyanine Green; D007223:Infant; D008297:Male; D010865:Pilot Projects; D011171:Portoenterostomy, Hepatic / Q000379:methods*; D015642:Radiology, Interventional
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Biliary atresia; Hepatoportoenterostomy; Indocyanine green fluorescence cholangiography; Kasai procedure