Assessment of colonic interposition graft using indocyanine green: expanding fluorescence imaging techniques in gastrointestinal surgery

Indocyanine green (ICG) fluorescence is a well-established intra-operative imaging technique used to assess adequate tissue perfusion in bowel anastomoses. Current evidence shows it to be a cost-effective and safe procedure effective in reducing anastomotic leak rates in colorectal anastomoses. However, the application of this imaging method to assess viability of colonic conduits in the upper gastrointestinal tract is rarely accounted for in the literature. Colonic interposition grafting following oesophagectomy is a complex procedure that carries many risks including conduit ischaemia or anastomotic leak, which are life-threatening complications. We present a case of a 55-year-old gentleman who underwent delayed oesophageal reconstruction with a colonic interposition graft following oesophageal conduit necrosis complicating an Ivor-Lewis oesophagectomy. To decrease risk of morbidity, ICG was administered intravenously to assess sufficient perfusion at the oesophago-colonic and entero-colonic anastomotic sites.