TY  - JOUR
A1  - Lobbes, Leonard A.
A1  - Hoveling, Richelle J. M.
A1  - Berns, Susanne
A1  - Schmidt, Leonard R.
A1  - Strobel, Rahel M.
A1  - Schineis, Christian
A1  - Lauscher, Johannes C.
A1  - Beyer, Katharina
A1  - Weixler, Benjamin
T1  - Feasibility of novel software-based perfusion indicators for the ileal J-pouch — on the path towards objective and quantifiable intraoperative perfusion assessment with indocyanine green near-infrared fluorescence
T2  - Life
N2  - Background: In restorative proctocolectomy with ileal J-pouch, perfusion assessment is vital to prevent complications such as anastomotic leak (AL). Indocyanine green near-infrared fluorescence (ICG-NIRF) is gaining popularity, while its interpretation and relevance remain subjective. This study aimed to evaluate a standardized ICG-NIRF imaging protocol combined with a novel, software-based assessment to detect areas of impaired perfusion and a possible correlation with AL of the pouch. 

Methods: In this prospective study, patients undergoing ileal J-pouch for ulcerative colitis at an inflammatory bowel disease (IBD) referral center were included. Intraoperatively, strictly standardized ICG-NIRF visualization was performed and video-recorded. Postoperatively, a specific software was utilized to determine the change in fluorescence intensity per second (i/s) for systematic regions of interest, generating perfusion-time curves and a pixel-to-pixel map. These were analysed in detail and correlated with clinical outcome (primary end point: AL within 30 days; clearly defined and screened for by pouchoscopy). 

Results: Four out of 18 included patients developed AL of the ileal pouch-anal anastomosis (IPAA). In the AL group, the perfusion curves on the area adjacent to the IPAA (pouch apex) displayed considerably lower ingress/inflow (median = 1.7; range = 8.5; interquartile-range = 3.8 i/s) and egress/outflow (median = −0.1; range = 0.7; interquartile-range = 0.5 i/s) values than in the non-AL group (ingress: median = 4.3; range = 10.3; interquartile-range = 4.0 i/s); egress: median = (−1.1); range = 3.9; interquartile range = 1.0 i/s). This was confirmed by further novel parameters of pouch perfusion (maximum ingress; maximum egress) and pixel-to-pixel analysis. 

Conclusions: This study presents the feasibility of a novel methodology to precisely assess pouch perfusion with ICG-NIRF, identifying comparable, quantifiable, and objective parameters to potentially detect perfusion-associated complications in surgery in real-time.
Y1  - 2022
UR  - https://opus.bibliothek.uni-augsburg.de/opus4/frontdoor/index/index/docId/123771
UR  - https://nbn-resolving.org/urn:nbn:de:bvb:384-opus4-1237717
SN  - 2075-1729
VL  - 12
IS  - 8
SP  - 1144
PB  - MDPI AG
CY  - Basel
ER  -