Basic Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2024; 16(6): 1825-1834
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1825
Peritoneal fluid indocyanine green test for diagnosis of gut leakage in anastomotic leakage rats and colorectal surgery patients
Yu Huang, Tian-Yang Li, Jie-Feng Weng, Hui Liu, Yu-Jie Xu, Shuai Zhang, Wei-Li Gu
Yu Huang, Tian-Yang Li, Jie-Feng Weng, Hui Liu, Yu-Jie Xu, Shuai Zhang, Wei-Li Gu, Department of Surgery, Guangzhou First People's Hospital, Guangzhou 510180, Guangdong Province, China
Author contributions: Huang Y and Gu WL conceived and designed the study; Huang Y and Li TY performed the animal research and collected the data; Huang Y and Weng JF performed the human research and collected the data and wrote the manuscript; Huang Y, Li TY and Zhang S analyzed and interpreted the data; Xu YJ and Liu H revised the manuscript; all authors have read and approved the final manuscript.
Supported by the Science and Technology Projects in Guangzhou, No. 202201010623 and No. 2024A03J1016; Guangzhou Science and Technology Project of Traditional Chinese Medicine and Combined Chinese and Western Medicine, No. 20242A011001; and Guangdong Medical Science and Research Foundation, No. A2024088.
Institutional review board statement: The study was reviewed and approved by the Guangzhou First People’s Hospital Institutional Review Board (Approval No. K-2019-173-01).
Institutional animal care and use committee statement: All procedures involving animals were reviewed and approved by the Institutional Animal Care and Use Committee of the Second Affiliated Hospital of South China University of Technology (Protocol No. 2022079).
Conflict-of-interest statement: The authors do not have any conflict of interest to declare.
Data sharing statement: The authors declare that the data supporting the findings of this study are available within the article or from the corresponding authors upon request.
ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu Huang, MD, PhD, Doctor, Department of Surgery, Guangzhou First People's Hospital, No. 1 Panfu Road, Yuexiu District, Guangzhou 510180, Guangdong Province, China. eyhy@scut.edu.cn
Received: January 13, 2024
Revised: April 22, 2024
Accepted: May 6, 2024
Published online: June 27, 2024
Processing time: 168 Days and 5.9 Hours
Abstract
BACKGROUND

Application of indocyanine green (ICG) fluorescence has led to new developments in gastrointestinal surgery. However, little is known about the use of ICG for the diagnosis of postoperative gut leakage (GL). In addition, there is a lack of rapid and intuitive methods to definitively diagnose postoperative GL.

AIM

To investigate the effect of ICG in the diagnosis of anastomotic leakage in a surgical rat GL model and evaluate its diagnostic value in colorectal surgery patients.

METHODS

Sixteen rats were divided into two groups: GL group (n = 8) and sham group (n = 8). Approximately 0.5 mL of ICG (2.5 mg/mL) was intravenously injected postoperatively. The peritoneal fluid was collected for the fluorescence test at 24 and 48 h. Six patients with rectal cancer who had undergone laparoscopic rectal cancer resection plus enterostomies were injected with 10 mL of ICG (2.5 mg/mL) on postoperative day 1. Their ostomy fluids were collected 24 h after ICG injection to identify the possibility of the ICG excreting from the peripheral veins to the enterostomy stoma. Participants who had undergone colectomy or rectal cancer resection were enrolled in the diagnostic test. The peritoneal fluids from drainage were collected 24 h after ICG injection. The ICG fluorescence test was conducted using OptoMedic endoscopy along with a near-infrared fluorescent imaging system.

RESULTS

The peritoneal fluids from the GL group showed ICG-dependent green fluorescence in contrast to the sham group. Six samples of ostomy fluids showed green fluorescence, indicating the possibility of ICG excreting from the peripheral veins to the enterostomy stoma in patients. The peritoneal fluid ICG test exhibited a sensitivity of 100% and a specificity of 83.3% for the diagnosis of GL. The positive predictive value was 71.4%, while the negative predictive value was 100%. The likelihood ratios were 6.0 for a positive test result and 0 for a negative result.

CONCLUSION

The postoperative ICG test in a drainage tube is a valuable and simple technique for the diagnosis of GL. Hence, it should be employed in clinical settings in patients with suspected GL.

Keywords: Gut leakage, Indocyanine green, Anastomotic leakage model, Diagnostic test, Diagnostic technique

Core Tip: This study demonstrates the effectiveness of the peritoneal fluid indocyanine green (ICG) test in detecting postoperative gut leakage (GL) using rat models of surgical GL. The ICG test is a highly useful tool for diagnosing GL in patients with colorectal surgery. Our proposed method is a simple technique that can be used for both diagnosing and ruling out GL.