Indocyanine green fluorescence imaging for subtotal esophagectomy due to esophageal stenosis after acute esophageal necrosis: a report of two cases

Although esophageal stricture after acute esophageal necrosis (AEN) is often refractory to dilation therapy, there have been few reports of surgical intervention. We report two rare cases of successful subtotal esophagectomy and esophagogastrostomy for esophageal strictures after AEN using indocyani...

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Bibliographic Details
Published in:	Clinical journal of gastroenterology Vol. 14; no. 2; pp. 415 - 421
Main Authors:	Imaoka, Kouki, Harano, Masao, Oshita, Ko, Yano, Takuya, Kubota, Tetsushi, Yoshimitsu, Masanori, Nakano, Kanyu, Idan, Hitoshi, Shiozaki, Shigehiro, Okajima, Masazumi
Format:	Journal Article
Language:	English
Published:	Singapore Springer Singapore 01-04-2021
Subjects:	Abdominal Surgery Case Report Colorectal Surgery Gastroenterology Hepatology Medicine Medicine & Public Health Surgical Oncology Indocyanine green fluorescence imaging Esophagectomy Acute esophageal necrosis Black esophagus Bypass operation
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Summary:	Although esophageal stricture after acute esophageal necrosis (AEN) is often refractory to dilation therapy, there have been few reports of surgical intervention. We report two rare cases of successful subtotal esophagectomy and esophagogastrostomy for esophageal strictures after AEN using indocyanine green (ICG) fluorescence imaging. In case 1, emergent esophagogastroduodenoscopy (EGD) in a 56-year-old man with coffee-ground emesis revealed black esophageal mucosa in the middle to lower esophagus, indicating AEN. Despite conservative therapy, an esophageal stricture developed after 2 weeks. Repeated endoscopic balloon dilation (EBD) did not resolve the stenosis; esophagectomy was thus performed approximately 6 months after AEN onset. We evaluated the blood flow to the esophagus using ICG fluorescence imaging to determine the proximal surgical resection line. The postoperative course was uneventful. In case 2, an 81-year-old woman with upper gastrointestinal bleeding with hematemesis and chest pain was diagnosed with AEN by EGD and was treated with conservative therapy. An esophageal stricture developed after 3 weeks, and repeated EBD was ineffective. Approximately 2 months after AEN onset, she underwent esophagectomy using ICG fluorescence imaging. The postoperative course was uneventful. Considering that AEN is a blood flow disorder, ICG fluorescence imaging is a useful technology to prevent surgical morbidity.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1865-7257 1865-7265
DOI:	10.1007/s12328-020-01326-x