Gastric Ischemic Preconditioning – Effect of Prior Ligation of Left and Right Gastric Arteries on Measured Perfusion During Esophagectomy

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ID: 315743
2026
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Abstract
Abstract Background Esophagectomy is the mainstay for treatment of esophageal cancer; however, it carries a high morbidity. Patient factors, neoadjuvant treatment, invasiveness, type of esophagectomy and necessity to create a gastric conduit supplied by only one artery are factors associated with anastomotic insufficiency and conduit necrosis. Gastric ischemic preconditioning, achieved by ligation of the left and right gastric arteries before esophagectomy, promotes neovascularization and collateral development. Aims To compare the perfusion of gastric conduits with (Lig+) and without ischemic preconditioning (Lig-). Methods Three weeks prior to esophagectomy, ligation of the left and right gastric arteries was performed laparoscopically. During esophagectomy, a standardized dosage of ICG was injected after creation of the gastric conduit. OR videos of patients were retrospectively assessed by a blinded reviewer. Measured were the topmost perfused points in the conduit (Pmax) from the tip in cm, the time interval of ICG to reach Pmax in seconds (t1) starting at the diaphragmatic level, and the time to maximum perfusion of Pmax (t2). Results Of 51 included OR videos, 11 were excluded (conduit not visualized in standardized fashion). The mean distance from Pmax to the tip of the conduit was 4.15cm (standard deviation ± 3.33cm) in Lig-, and 1.67±1.9cm in Lig+-patients (p=0.03). Mean t1 in Lig- was 20.45±7.96 sec and in Lig+ 17.48±4.38 sec (p=0.28). Mean t2 in Lig- was 31.18±9.03 sec and in Lig+ 22.24±6.36 sec (p=0.01). The time interval from t1 to t2 at Pmax was 10.73±7.74 sec in Lig- and 4.76±2.72 in Lig+ (p=0.03). There were significant differences between the length of non-perfused conduit-tips and the time to maximal perfusion (t2) at Pmax. Conclusion Gastric ischemic preconditioning improves perfusion to gastric conduits during esophagectomy, which may positively affect anastomotic healing.
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Authors A Schmid, S Gerber, P Aeschbacher, D Candinas, D Kröll, Y Borbély
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag055.064
URL
https://doi.org/10.1093/bjs/znag055.064
Keywords Keywords not found

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