scholarly journals Comparison of Optical Imaging Techniques to Quantitatively Assess the Perfusion of the Gastric Conduit during Oesophagectomy

2020 ◽  
Vol 10 (16) ◽  
pp. 5522
Author(s):  
Maxime D. Slooter ◽  
Sanne M. A. Jansen ◽  
Paul R. Bloemen ◽  
Richard M. van den Elzen ◽  
Leah S. Wilk ◽  
...  
Keyword(s):  
Optical Imaging ◽  
Anastomotic Leakage ◽  
Imaging Techniques ◽  
Gastric Conduit ◽  
Laser Speckle ◽  
Fluorescence Angiography ◽  
Optical Techniques ◽  
Quantitative Perfusion ◽  
Quantitative Parameters ◽  
Perfusion Assessment

In this study, four optical techniques—Optical Coherence Tomography, Sidestream Darkfield Microscopy, Laser Speckle Contrast Imaging, and Fluorescence Angiography (FA)—were compared on performing an intraoperative quantitative perfusion assessment of the gastric conduit during oesophagectomy. We hypothesised that the quantitative parameters show decreased perfusion towards the fundus in the gastric conduit and in patients with anastomotic leakage. In a prospective study in patients undergoing oesophagectomy with gastric conduit reconstruction, measurements were taken with all four optical techniques at four locations from the base towards the fundus in the gastric conduit (Loc1, Loc2, Loc3, Loc4). The primary outcome included 14 quantitative parameters and the anastomotic leakage rate. Imaging was performed in 22 patients during oesophagectomy. Ten out of 14 quantitative parameters significantly indicated a reduced perfusion towards the fundus of the gastric conduit. Anastomotic leakage occurred in 4/22 patients (18.4%). At Loc4, the FA quantitative values for “T1/2” and “mean slope” differed between patients with and without anastomotic leakage (p = 0.025 and p = 0.041, respectively). A quantitative perfusion assessment during oesophagectomy is feasible using optical imaging techniques, of which FA is the most promising for future research.

scholarly journals Quantitative fluorescence-guided perfusion assessment of the gastric conduit to predict anastomotic complications after esophagectomy

2020 ◽  
Author(s):  
M D Slooter ◽  
D M de Bruin ◽  
W J Eshuis ◽  
D P Veelo ◽  
S van Dieren ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Anastomotic Stricture ◽  
Area Under The Curve ◽  
Gastric Conduit ◽  
Fluorescence Angiography ◽  
Anastomotic Site ◽  
Anastomotic Complications ◽  
Risk Patients ◽  
Perfusion Assessment

Summary Background: Fluorescence angiography (FA) assesses anastomotic perfusion during esophagectomy with gastric conduit reconstruction, but its interpretation is subjective. This study evaluated time to fluorescent enhancement in the gastric conduit, with the aim to determine a threshold to predict postoperative anastomotic complications. Methods: In a prospective cohort study, all consecutive patients undergoing esophagectomy with gastric conduit reconstruction from July 2018 to October 2019 were included. FA was performed before anastomotic reconstruction following injection of indocyanine green (ICG). During FA, the following time points were recorded: ICG injection, first fluorescent enhancement in the lung, at the base of the gastric conduit, at the planned anastomotic site, and at ICG watershed or in the tip of the gastric conduit. Anastomotic complications including anastomotic leakage and clinically relevant strictures were documented. Results: Eighty-four patients were included, the majority (67 out of 84, 80%) of which underwent an Ivor Lewis procedure. After a median follow-up of 297 days, anastomotic leakage was observed in 12 out of 84 (14.3%) and anastomotic stricture in 12 out of 82 (14.6%). Time between ICG injection and enhancement in the tip was predictive for anastomotic leakage (P = 0.174, area under the curve = 0.731), and a cut-off value of 98 seconds was derived (specificity: 98%). All times to enhancement at the planned anastomotic site and ICG watershed were significantly predictive for the occurrence of a stricture, however area under the curves were <0.7. Conclusions: The identified fluorescent threshold can be used for intraoperative decision making or to identify potentially high-risk patients for anastomotic leakage after esophagectomy with gastric conduit reconstruction.

663 QUANTITATIVE PERFUSION ASSESSMENT TO PREDICT ANASTOMOTIC LEAK AFTER ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Yoshitaka Ishikawa ◽  
Christopher Breuler ◽  
Andrew C Chang ◽  
Jules Lin ◽  
Mark B Orringer ◽  
...  
Keyword(s):  
Anastomotic Leak ◽  
Anastomotic Stricture ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Gastric Conduit ◽  
Fluorescence Angiography ◽  
Operative Care ◽  
Significant Difference ◽  
Perfusion Assessment ◽  
Mckeown Esophagectomy

Abstract   Impaired gastric conduit perfusion is a risk factor for anastomotic leak after esophagectomy. Most studies evaluating conduit perfusion have been qualitative with limited impact on post-operative care. The aim of this study is to evaluate the feasibility of intraoperative quantitative assessment of gastric conduit perfusion with indocyanine green (ICG) fluorescence angiography as a predictor for cervical esophagogastric anastomotic (CEGA) leak after esophagectomy. Methods ICG fluorescence angiography using the SPY elite® (Stryker, MI, USA) system was performed in patients who had undergone a transhiatal or McKeown esophagectomy CEGA from July 2015 through December 2020. Fluorescence angiography assessed Ingress (dye uptake) and Egress (dye exit). Ingress Index, Ingress Time, Egress Index, and Egress Time at two anatomic landmarks (tip of the conduit, and 5 cm from tip) were calculated from the measured curve of fluorescence (Figure). The collected data between the leak (L) group and the no-leak (NL) group were compared by both univariate and multivariable analyses to analyze risk factors potentially associated with CEGA leak. Results 304 patients were evaluated. There was no significant difference in patients' demographic and post-operative complications between the groups (L n = 73; NL n = 231), except for anastomotic stricture (42.5 vs 9.1%, p < 0.01). 5 cm and Tip Ingress Index were significantly lower in L (35.0 vs 45.1% and 17.4 vs 25.7%, p < 0.01). 5 cm Ingress Time was significantly higher in L (70.6 vs 56.8 sec, p < 0.01). On multivariable analysis, these variables retained statistical significance, suggesting that these three variables can be used to predict future leak. Conclusion This study revealed that gastric conduit perfusion correlates with the incidence of CEGA leak. Intraoperative measurement of gastric conduit perfusion may be predictive for CEGA leak following esophagectomy. These variables can be easily collected intraoperatively with the SPY study and used to make clinical decisions which may avert CEGA leak.

FA05.03: EFFECT OF EPHEDRINE ON GASTRIC CONDUIT PERFUSION MEASURED BY LASER SPECKLE CONTRAST IMAGING (LSCO) AFTER ESOPHAGECTOMY: A PROSPECTIVE IN-VIVO COHORT STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 10-10
Author(s):  
Sanne Jansen ◽  
Daniel De Bruin ◽  
Simon Strackee ◽  
Mark I Van Berge Henegouwen ◽  
Ton Van Leeuwen ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Gastric Conduit ◽  
Laser Speckle ◽  
Contrast Imaging ◽  
Laser Speckle Contrast Imaging ◽  
Speckle Contrast ◽  
Before And After ◽  
Gastric Tube Reconstruction

Abstract Background Compromised perfusion due to ligation of arteries and veins in esophagectomy with gastric tube reconstruction often (5–20%) results in necrosis and anastomotic leakage, which relate to high morbidity and mortality (3–4%). Ephedrine is used widely in anesthesia to treat intra-operative hypotension and may improve perfusion by the increase of cardiac output (CO) and mean arterial pressure (MAP). This study tests the effect of ephedrine on perfusion of the future anastomotic site of the gastric conduit, measured by Laser Speckle Contrast Imaging (LSCI). Methods This prospective, observational, in-vivo pilot study includes 26 patients undergoing esophagectomy with gastric tube reconstruction from October 2015 to June 2016 in the Academic Medical Center (Amsterdam). Perfusion of the gastric conduit was measured with LSCI directly after reconstruction and after an increase of MAP by ephedrine 5 mg. Perfusion was quantified in flux (LSPU) in four perfusion locations, from good perfusion (base of the gastric tube) towards decreased perfusion (fundus). Intra-patient differences before and after ephedrine in terms flux were statistically tested for significance with a paired t-test. Results LSCI was feasible to image gastric microcirculation in all patients. Flux (LSPU) was significantly higher in the base of the gastric tube (791 ± 442) compared to the fundus (328 ± 187) (P < 0.001). After administration of ephedrine, flux increased significantly in the fundus (P < 0·05) measured intra-patients. Three patients developed anastomotic leakage. In these patients, the difference between measured flux in the fundus compared to the base of the gastric tube was high. Conclusion This study presents the effect of ephedrine on perfusion of the gastric tissue measured with LSCI in terms of flux (LSPU) after esophagectomy with gastric tube reconstruction. We show a small but significant difference between flux measured before and after administration of ephedrine in the future anastomotic tissue (313 ± 178 vs. 397 ± 290). We also show a significant decrease of flux towards the fundus. Disclosure All authors have declared no conflicts of interest.

P87 FLUORESCENCE ANGIOGRAPHY OF THE ANASTOMOTIC SITE DURING ESOPHAGECTOMY: TIME TO ENHANCEMENT AS QUANTITATIVE VALUE TO PREDICT ANASTOMOTIC LEAKAGE

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
M D Slooter¹ ◽  
D M de Bruin ◽  
W J Eshuis¹ ◽  
S S Gisbertz¹ ◽  
M I van Berge Henegouwen¹
Keyword(s):  
Anastomotic Leakage ◽  
Area Under The Curve ◽  
Gastric Conduit ◽  
Fluorescence Angiography ◽  
Anastomotic Site ◽  
Roc Curve Analysis ◽  
Time Points ◽  
The Difference ◽  
Tip Injection ◽  
One Year

Abstract Aim In this study we correlated time to fluorescent enhancement as a quantitative value of intraoperative fluorescence angiography (IFA) to anastomotic leakage (AL) after esophagectomy with gastric conduit reconstruction. Background & Methods IFA seems a helpful technique to visualize anastomotic perfusion after esophagectomy. However, IFA is interpreted subjectively. To evaluate fluorescence objectively and find a threshold to predict AL, we evaluated time to fluorescence enhancement. All consecutive patients undergoing elective esophagectomy with gastric conduit reconstruction for a one-year period since the introduction of IFA in June 2018 were prospectively recorded. IFA was performed after injection of indocyanine green (ICG) before and/or after anastomotic reconstruction. During IFA, time to fluorescent enhancement was recorded (time points: ICG injection, enhancement in lung, base of gastric conduit, planned anastomotic site, tip of gastric conduit). The anastomotic site was changed according to subjective interpretation of IFA. AL was classified according to the ECCG classification. Results Sixty-five patients underwent esophagectomy with gastric conduit reconstruction for esophageal cancer. The anastomosis was either constructed in the cervical (13/65, 20%) or intrathoracic (52/65, 80%) region. The anastomotic site was adjusted due to IFA in 3/65 (4.6%) cases. AL occurred in 7/65 (10.8%) patients and in 1/3 (33.3%) after change of anastomotic site. Before anastomotic reconstruction, time between ICG injection and enhancement of the tip (injection-tip) and time between enhancement in the lung and base of the conduit (lung-conduit) were significantly correlated with AL (p=0.027 and p=0.042, respectively). ROC curve analysis revealed a cut-off value of 61 seconds for injection-tip with an area under the curve (AUC) of 0.91 and corresponding sensitivity 82.9% and specificity 100%. For lung-conduit a cut-off value of 11 seconds was found with an AUC of 0.71 and corresponding sensitivity 63% and specificity 83%. Conclusion In this study cut-off values for the time between injection-tip and lung-conduit were derived to predict AL after esophagectomy. Time to fluorescent enhancement is a quantitative fluorescent parameter, which is easy to implement, as no software is required. However, a larger cohort needs to be observed for potential significance of the difference between other time points and to confirm these thresholds.

scholarly journals Biophotonics Modalities for High-Resolution Imaging of Microcirculatory Tissue Beds Using Endogenous Contrast: A Review on Present Scenario and Prospects

2011 ◽  
Vol 2011 ◽  
pp. 1-20 ◽  
Author(s):  
Hrebesh M. Subhash
Keyword(s):  
High Resolution ◽  
Optical Imaging ◽  
Perfusion Imaging ◽  
Imaging Techniques ◽  
Laser Speckle ◽  
Contrast Imaging ◽  
Endogenous Contrast ◽  
Contrast Mechanism ◽  
Recent Developments ◽  
Resolution Imaging

The microcirculation is a complex system, and the visualization of microcirculation has great significance in improving our understanding of pathophysiological processes in various disease conditions, in both clinical and fundamental studies. A range of techniques are available or emerging for investigating different aspect of the microcirculation in animals and humans. This paper reviews the recent developments in the field of high-resolution and high-sensitive optical imaging of microcirculatory tissue beds, emphasizing technologies that utilize the endogenous contrast mechanism. Optical imaging techniques such as intravital microscopy, Capillaroscopy, laser Doppler perfusion imaging, laser speckle perfusion imaging, polarization spectroscopy, photo-acoustic tomography, and various implementations of optical coherence tomography based on Doppler and speckle contrast imaging are presented together with their prospectives and challenges.

scholarly journals Optical imaging techniques for rice diseases detection: A review

2020 ◽  
Vol 1 (1) ◽  
pp. 1-11
Keyword(s):  
Optical Imaging ◽  
Multispectral Imaging ◽  
Imaging Techniques ◽  
Management Strategies ◽  
Economic Losses ◽  
Depth Information ◽  
Optical Techniques ◽  
Rice Disease ◽  
Potential Applications ◽  
Current Assessment

Rice diseases have caused great economic losses to farmers in rice cultivation. The current assessment of rice disease evaluation still relies on manual, subjective, and laborious techniques. The manual and subjective evaluations lead to uncertainties since some diseases have almost similar characterisation. The applications of immunological, molecular, and microscope techniques are time-consuming, costly, and skills dependent. Thus, optical techniques are recommended to facilitate the control of diseases through their feasibility, rapidity, and accuracy, which can lead to better management strategies, besides improving production activity. These techniques for detecting and monitoring the diseases are important for precaution and prevention action. The present review discusses the existing and potential optical techniques for the detection of rice diseases. The techniques include optical imaging that consists of computer vision, spectroscopy, multispectral imaging, hyperspectral imaging (HSI), and remote sensing. Thus, this work presents in-depth information related to the nondestructive and potential applications of optical imaging techniques for rice disease detection.

Laser Speckle Contrast Imaging for Intraoperative Quantitative Assessment of Intestinal Blood Perfusion During Colorectal Surgery: A Prospective Pilot Study

2019 ◽  
Vol 26 (3) ◽  
pp. 293-301 ◽  
Author(s):  
Shigehiro Kojima ◽  
Tsuguo Sakamoto ◽  
Yuko Nagai ◽  
Yutaka Matsui ◽  
Kyojiro Nambu ◽  
...  
Keyword(s):  
Pilot Study ◽  
Colorectal Surgery ◽  
Intraclass Correlation ◽  
Laser Speckle ◽  
Fluorescence Angiography ◽  
Contrast Imaging ◽  
Flow Measurements ◽  
Laser Speckle Contrast Imaging ◽  
Speckle Contrast ◽  
Perfusion Assessment

Background. The main limitation of perfusion assessment with indocyanine green fluorescence angiography during colorectal surgery is that the surgeon assesses the quality of perfusion subjectively. The ideal intestinal viability test must be minimally invasive, objective, and reproducible. We evaluated the quantitativity and reproducibility of laser speckle contrast imaging for perfusion assessment during colorectal surgery. Methods. This was a prospective, nonrandomized, pilot study of 8 consecutive patients who underwent elective left-sided colorectal resection. Laser speckle perfusion images at the site of proximal transection of the bowel were obtained intraoperatively. We tested the hypothesis that laser speckle contrast imaging was able to quantitatively identify areas of diminished intestinal perfusion after devascularization and assessed the reproducibility of this method. Results. All surgical procedures were uneventful and blood flow measurements were successfully made in all patients. None of the patients developed postoperative complications related to the anastomosis and stoma. Data analyses were successfully optimized to perform quantitative regional perfusion assessments in all cases. The bowel tissue blood flows of the anal side region adjacent to the transection line were significantly lower than those of the oral side region adjacent to the transection line after ligation of marginal vessels ( P = .012). Interrater reliability was high (intraclass correlation coefficients = 0.989), and a Bland-Altman plot showed few differences of mean flux data between 2 investigators. Conclusion. Laser speckle contrast imaging is feasible for real-time assessment of bowel perfusion with quantitativity and excellent reproducibility during colorectal surgery without administration of any contrast agents.

Laser speckle contrast imaging and quantitative fluorescence angiography for perfusion assessment

2019 ◽  
Vol 404 (4) ◽  
pp. 505-515 ◽  
Author(s):  
Jonas Hedelund Rønn ◽  
Nikolaj Nerup ◽  
Rune Broni Strandby ◽  
Morten Bo Søndergaard Svendsen ◽  
Rikard Ambrus ◽  
...  
Keyword(s):  
Laser Speckle ◽  
Fluorescence Angiography ◽  
Contrast Imaging ◽  
Laser Speckle Contrast Imaging ◽  
Speckle Contrast ◽  
Perfusion Assessment ◽  
Quantitative Fluorescence

scholarly journals Novel Optical Techniques for Imaging Microcirculation in the Diabetic Foot

2018 ◽  
Vol 24 (12) ◽  
pp. 1304-1316 ◽  
Author(s):  
Onno A. Mennes ◽  
Jaap J. van Netten ◽  
Riemer H.J.A. Slart ◽  
Wiendelt Steenbergen
Keyword(s):  
Diabetic Foot ◽  
Clinical Relevance ◽  
Imaging Techniques ◽  
Laser Speckle ◽  
Foot Ulcers ◽  
Future Research ◽  
Diabetic Foot Ulcers ◽  
Contrast Imaging ◽  
Optical Techniques ◽  
Advantages And Disadvantages

Background: The most severe diabetic foot ulcers are those related with critical ischemia, which is primarily diagnosed with non-invasive diagnostics. However, these diagnostics have several disadvantages. For example, they only provide global indications of the (macro)level of ischemia. A potential solution can be found in novel optical imaging techniques for local assessment of the microcirculation in diabetic foot ulcers. This review provides an overview of these imaging techniques (Laser Doppler Perfusion Imaging, Laser Speckle Contrast Imaging, Photoacoustic Imaging and Hyperspectral Imaging) and their applicability for the diagnostic assessment of microcirculation in diabetic foot ulcers. <p> Method: For each technique, the following parts are described: a) their technical background; b) general clinical applications; and, c) its application for microcirculation assessment in diabetic foot ulcers. Parts a-b are based on a narrative review of the literature, part c on a systematic review that was performed in the database Scopus, covering the period from January 1, 2000 to November 31, 2017. <p> Results: Each of these techniques has specific advantages and disadvantages for imaging microcirculation. Potential clinical use depends on measurement aims, and clinical relevance. However, none of the techniques has a strongly established clinical relevance yet: we found a limited number of publications describing clinical outcomes. Future research is needed to determine which technique is the most clinically relevant for the assessment of microcirculation in diabetic foot ulcers. Conclusion: Although promising, the currently available novel optical techniques need to be further improved technically and prospective trials are necessary to evaluate their clinical value.

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