Indocyanine Green Near Infrared Fluorescence Imaging for Colonic Conduit Perfusion Assessment in Colon Pull-up for Corrosive Oesophageal Strictures

Subjective visual assessment (SVA) of colour, pulsations and bleeding from cut edges is unreliable in predicting conduit perfusion during colon pull-up surgery for corrosive oesophageal strictures. This prospective study evaluated whether Indocyanine green fluorescence imaging (ICG-FI) had any additive role to routine subjective visual assessment of conduit perfusion. A total of 20 consecutive patients who underwent colonic transposition for corrosive oesophageal strictures from September 2017 to July 2019 were included. Nineteen patients underwent a right colon pull-up and 1 patient underwent a left colon pull-up. Proximal pharyngeal and oesophageal anastomosis was done in 14 and 6 patients, respectively. SVA along with ICG-FI was done for assessment of conduit perfusion after transection of ileum, after transposition of colon to neck and after completion of the neck anastomosis. If needed, change in operative strategy was done based on the SVA of conduit. Anastamotic leak rate was 20% ( n = 4, grade I leak = 2, grade II leak = 2). SVA detected hypoperfusion in 2 patients (grade I leak = 1, grade II leak = 1) requiring a left colon pull-up instead of right colon and a conduit revision in these patients which was confirmed by ICG-FI. ICG-FI detected hypoperfusion in an additional patient. A single patient with a grade I leak had normal perfusion both on SVA and ICG-FI. ICG-FI detected hypoperfusion in 75% compared to 50% by SVA in patients who subsequently developed an anastamotic leak. In conclusion, ICG-FI can augment subjective visual assessment of conduit perfusion by picking up subtle hypoperfusion defects.