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

Abstract

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.

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Acknowledgements

We would like to thank Editage (www.editage.jp) for the English language editing.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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KI drafted the manuscript and treated the patient. MH treated the patient and helped to draft the manuscript. KI, KO, TY, KT, MY, KN, MH, and HM treated the patient. HI, SS, and MO determined the treatment plan and revised the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Masao Harano.

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Kouki Imaoka, Masao Harano, Ko Oshita, Takuya Yano, Tetsushi Kubota, Masanori Yoshimitsu, Kanyu Nakano, Hitoshi Idani, Shigehiro Shiozaki, Masazumi Okajima declare that they have no conflict of interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Imaoka, K., Harano, M., Oshita, K. et al. Indocyanine green fluorescence imaging for subtotal esophagectomy due to esophageal stenosis after acute esophageal necrosis: a report of two cases. Clin J Gastroenterol (2021). https://doi.org/10.1007/s12328-020-01326-x

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Keywords

  • Acute esophageal necrosis
  • Black esophagus
  • Indocyanine green fluorescence imaging
  • Esophagectomy
  • Bypass operation