The of Effect of Indocyanine Green Angiography on Anastomotic Stricture Rate After Esophagectomy
*Pooja T Desai, *Osler Turner, Edward Borrazzo
University of Vermont Medical Center, Burlington, VT
Objective: Anastomotic stricture is a post-operative complication after esophagectomy, likely the result of poor gastric conduit perfusion. Recently, surgeons have begun utilizing intra-operative indocyanine green (ICG) angiography to visualize areas of vascular insufficiency in the gastric conduit that may impede anastomotic healing. The objective of this study was to evaluate the effectiveness of ICG angiography to modify the gastric conduit and reduce anastomotic stricture rate after esophagectomy. Design: A retrospective chart review of patients who underwent esophagectomy was conducted to assess surgical technique with and without ICG angiography and anastomotic stricture formation. Cases were reviewed for two time periods, comparing groups before and after use of ICG angiography. Setting: Tertiary Referral Center. Patients: All patients who underwent esophagectomy from 2005-2019. Interventions: Intravenous ICG was administered to patients intra-operatively to visualize gastric conduit perfusion. Main Outcome Measures: Decrease in anastomotic stricture rate in patients with intraoperative ICG angiography. Results: 125 patients underwent esophagectomy with and without ICG angiography and were reviewed for evidence of anastomotic stricture. 48 of the 125 patients had intra-operative assessment of gastric conduit perfusion with ICG angiography. 20% of all patients developed strictures -- 18.8% with use of ICG angiography versus 20.8% of patients without ICG angiography assessment (p=0.78). Conclusions: This is the first study evaluating the utility of ICG angiography to modify the gastric conduit and reduce anastomotic strictures after esophagectomy. Although this is a promising new technology, the rate of anastomotic stricture formation after esophagectomy does not appear to be influenced by intra-operative ICG angiography. 
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