Outcomes of near-infrared fluorescence guided colonic interposition for corrosive esophageal stricture

Introduction

Colonic interposition is the most commonly performed surgery for high corrosive esophageal or combined esophagogastric strictures. Here, we present the outcomes of colonic interposition using a modified right colonic graft and the utility of indocyanine green–guided fluorescence imaging.

Methods

We retrospectively reviewed the medical records of 30 patients with corrosive esophageal strictures who underwent colon interposition surgery between July 2017 and December 2023. The ascending colon, without including the ileocecal valve, and with the transverse colon, which was determined by the ascending branch of the left colic artery in an isoperistaltic fashion, was used in all patients. Vascularity was assessed after clamping the marginal and middle colic arteries using near-infrared fluorescence imaging, and any changes in management based on fluorescence imaging were noted. Short- and long-term outcomes also were analyzed.

Results

Among the 30 patients, 20 were male, with a median age of 32 (20–59) years. Only 1 patient (3.3%) had conduit necrosis and underwent re-exploration with necrotic segment removal with esophagostomy. Among the 4 patients who had abdominal anastomotic leaks, 2 were managed conservatively and 2 underwent re-exploration. Twenty-five patients (83.3%) had a median weight gain of 5 (3–25) kg. Five patients (16.6%) had anastomotic stricture, of whom 4 were successfully managed with endoscopic dilatation. The median EuroQol 5-Dimension 5-level health scale score was 90 (70–100).

Conclusion

Indocyanine green–guided fluorescence is a useful adjunct during colonic interposition and a modified right colonic graft provides a good quality of life.