Evidence map›Paper›PMID 32385707›Full record

ArticleSurgical endoscopy2020

Intraluminal indocyanine green for intraoperative staple line leak testing in bariatric surgery.

Christopher L Kalmar, Christopher M Reed, Curtis L Peery, Arnold D Salzberg

Registry-linked trialAbstract read
PubMed Publisher
In one paragraph

Article in Surgical endoscopy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05735964 (Indocyanine Green), which is not on this map. Cited by 11 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05735964 narecruitingnot on this mapstarted 2023, after this paper: background citation

Indocyanine Green (ICG) and Near Infrared Fluorescence (NIRF) Guided Assessment of the Bowel and Oesophageal Anastomosis During Repair of Oesophageal Atresia with Distal Trachea-oesophageal Fistula (OA/dTOF): a Cohort Pilot Study

TypeinterventionalSponsorBirmingham Women's and Children's NHS Foundation TrustRan2023 to 2026Enrolled20ConditionsTracheo-Esophageal Fistula with Atresia of EsophagusArmsIndocyanine green
3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Guideline
  3. Pooled it
  4. Pooled it
  5. Safety of indocyanine green use in bariatric and metabolic surgery.Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques · 2025
    Article
  6. Article
  7. Review
  8. Review
  9. Article
  10. Article
  11. Clinical Significance of Intra-operative Gastroscopy for Tumor Localization in Totally Laparoscopic Partial Gastrectomy.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2021
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Christopher L KalmarDepartment of Surgery, Virginia Tech Carilion, 1906 Belleview Ave SE, Roanoke, VA, 24014, USA. chriskalmarmd@gmail.com.
Christopher M ReedDepartment of Surgery, Virginia Tech Carilion, 1906 Belleview Ave SE, Roanoke, VA, 24014, USA.
Curtis L PeeryDepartment of Surgery, Sanford Health, Sioux Falls, SD, USA.
Arnold D SalzbergDepartment of Surgery, Virginia Tech Carilion, 1906 Belleview Ave SE, Roanoke, VA, 24014, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBariatric surgical procedures have recognized benefits for morbidly obese patients. Unfortunately, staple line leaks remain a profound complication after these procedures. Currently available intraoperative surveillance modalities have multiple drawbacks, such as requiring an available upper endoscope and experienced endoscopist. Additionally, increased procedure time and resources are needed to perform intraoperative endoscopy and maintain equipment.

methodsThis is a retrospective cohort study of all bariatric patients undergoing Roux-en-Y gastric bypass or sleeve gastrectomy procedures performed by one attending surgeon at a tertiary care facility designated as a bariatric surgical center of excellence. Patients were grouped based on procedure date being before (September 2016 to mid-October 2018) or after (mid-October 2018 to March 2019) implementation of a novel intraluminal indocyanine green leak testing protocol. Diluted indocyanine green was injected via orogastric bougie intraluminally at the location of the gastric staple line and observed with near-infrared imaging from the intraperitoneal perspective for evidence of immunofluorescence extravasation. Data from the electronic medical record and bariatric surgical outcomes database were gathered to analyze the sensitivity and specificity of this new intraoperative diagnostic modality.

resultsTotal of 196 patients underwent bariatric surgery with intraoperative leak testing using the gastroscopy method; of these, there were 3 false negatives and 193 true negatives. Total of 59 patients underwent bariatric surgery with intraoperative leak testing using the intraluminal ICG method; of these, there was 1 true positive, 1 false positive, 0 false negatives, and 57 true negatives. Indocyanine green leak testing had a sensitivity of 100.00% and specificity of 98.28%.

conclusionsIntraluminal indocyanine green is an alternative for intraoperative detection of staple line integrity during bariatric surgical procedures with comparable specificity to intraoperative gastroscopy.

Indexed as

Fluorescent DyesIndocyanine GreenAdultAgedAnastomotic LeakBariatric SurgeryFemaleGastrectomyGastric BypassGastroscopyHumansLasersMaleMiddle AgedObesity, MorbidRetrospective StudiesFluorescent DyesIndocyanine GreenBariatricGastroscopyICGIntraluminalLeak testingStaple line

Identifiers

PMID32385707

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.