TY - JOUR
T1 - Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion
T2 - a systematic review of clinical trials
AU - Degett, Thea Helene
AU - Andersen, Helene Schou
AU - Gögenur, Ismail
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Purpose: 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. Conclusion: 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.
AB - Purpose: 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. Conclusion: 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.
KW - Anastomotic leakage
KW - Fluorescence angiography
KW - Indocyanine green
KW - Intraoperative assessment
KW - Perfusion assessment
UR - http://www.scopus.com/inward/record.url?scp=84960378861&partnerID=8YFLogxK
U2 - 10.1007/s00423-016-1400-9
DO - 10.1007/s00423-016-1400-9
M3 - Article
C2 - 26968863
AN - SCOPUS:84960378861
SN - 1435-2443
VL - 401
SP - 767
EP - 775
JO - Langenbeck's Archives of Surgery
JF - Langenbeck's Archives of Surgery
IS - 6
ER -