title: Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials.
abstract: OBJECTIVE
  Anastomotic leakage following gastrointestinal surgery remains a frequent and serious complication associated with a high morbidity and mortality. Indocyanine green fluorescence angiography (ICG-FA) is a newly developed technique to measure perfusion intraoperatively. The aim of this paper was to systematically review the literature concerning ICG-FA to assess perfusion during the construction of a primary gastrointestinal anastomosis in order to predict anastomotic leakage.
  
  
  METHODS
  The following four databases PubMed, Scopus, Embase, and Cochrane were independently searched by two authors. Studies were included in the review if they assessed anastomotic perfusion intraoperatively with ICG-FA in order to predict anastomotic leakage in humans.
  
  
  RESULTS
  Of 790 screened papers 14 studies were included in this review. Ten studies (n = 916) involved patients with colorectal anastomoses and four studies (n = 214) patients with esophageal anastomoses. All the included studies were cohort studies. Intraoperative ICG-FA assessment of colorectal anastomoses was associated with a reduced risk of anastomotic leakage (n = 23/693; 3.3 % (95 % CI 1.97-4.63 %) compared with no ICG-FA assessment (n = 19/223; 8.5 %; 95 % CI 4.8-12.2 %). The anastomotic leakage rate in patients with esophageal anastomoses and intraoperative ICG-FA assessment was 14 % (n = 30/214). None of the studies involving esophageal anastomoses had a control group without ICG-FA assessment.
  
  
  CONCLUSIONS
  No randomized controlled trials have been published. ICG-FA seems like a promising method to assess perfusion at the site intended for anastomosis. However, we do not have the sufficient evidence to determine that the method can reduce the leak rate.
authors.affiliation: Center for Surgical Science (CSS), Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark. theadegett@gmail.com.
authors.forename: Thea Helene
authors.identifier: http://orcid.org/0000-0001-8224-6052
authors.initials: TH
authors.lastname: Degett
authors.affiliation: Center for Surgical Science (CSS), Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
authors.forename: Helene Schou
authors.initials: HS
authors.lastname: Andersen
authors.affiliation: Center for Surgical Science (CSS), Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
authors.forename: Ismail
authors.initials: I
authors.lastname: Gögenur
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000000981:diagnostic imaging / Q000209:etiology*; D004396:Coloring Agents; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D016343:Monitoring, Intraoperative; D011237:Predictive Value of Tests; D012307:Risk Factors
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Anastomotic leakage; Fluorescence angiography; Indocyanine green; Intraoperative assessment; Perfusion assessment