Gastric preconditioning via percutaneous angioembolization before esophagectomy in patients at high risk for esophageal leak Journal Article
| Authors: | Bevers, K. C.; Sewell, M.; Bott, M. J.; Sihag, S.; Park, B. J.; Ridouani, F.; Muñoz, F. G.; Santos, E.; Molena, D. |
| Article Title: | Gastric preconditioning via percutaneous angioembolization before esophagectomy in patients at high risk for esophageal leak |
| Abstract: | Anastomotic leaks and stenoses remain critical complications in esophagectomy and are related to conduit perfusion. Surgical gastric preconditioning has been described but requires additional surgery and creates scar tissue, potentially hindering future operation. We sought to evaluate the feasibility and safety of percutaneous gastric preconditioning by angioembolization to improve perfusion of gastric conduits before esophagectomy in a high-risk patient cohort. Patients pending an esophagectomy for cancer and deemed to be high risk for anastomotic complications underwent preconditioning by image-guided angioembolization. Preconditioning was performed on an outpatient basis by means of superselective embolization of the left gastric and short gastric arteries. Intraoperative conduit perfusion evaluation with indocyanine green and postoperative surgical outcomes was reviewed. Seventeen patients underwent gastric preconditioning, with no complications observed. Thirteen of the 17 patients ultimately underwent esophagectomy; the remaining four patients were not candidates for an operation. Patients proceeded to surgery a median of 23 days (interquartile range, 21-27 days) after preconditioning. The intraoperative indocyanine green perfusion of all conduits was appropriate, with no tip demarcation and with a median time to dye uptake of 20s (interquartile range, 15-20s). There were no anastomotic stenoses or leaks noted within the series. Gastric conduit preconditioning by percutaneous angioembolization of the left gastric and short gastric arteries can be performed safely and without operative delay in high-risk patients. Further evaluation of preconditioning for conduit optimization is warranted to limit the critical complications of anastomotic leak and stenosis in esophagectomy. © 2024 The Author(s). |
| Keywords: | clinical article; treatment outcome; aged; middle aged; cancer surgery; postoperative period; preoperative care; cohort analysis; vascularization; high risk patient; feasibility study; feasibility studies; intraoperative period; surgery; outpatient care; therapy; embolization, therapeutic; esophagus tumor; esophageal neoplasms; esophagectomy; esophageal cancer; stomach; prevention and control; anastomosis leakage; etiology; adverse event; ischemic preconditioning; anastomosis stenosis; anastomotic leak; procedures; artery perfusion; coloring agents; coloring agent; indocyanine green; humans; human; male; female; article; gastric artery; gastric conduit; artificial embolization; left gastric artery; gastric preconditioning |
| Journal Title: | Diseases of the Esophagus |
| Volume: | 37 |
| Issue: | 11 |
| ISSN: | 1120-8694 |
| Publisher: | Oxford University Press |
| Date Published: | 2024-11-01 |
| Start Page: | doae062 |
| Language: | English |
| DOI: | 10.1093/dote/doae062 |
| PUBMED: | 39110926 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Daniela Molena -- Source: Scopus |
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