Indocyanine green fluorescence for assessment of perfusion in intestinal anastomoses
Keywords:
Colorectal surgery, fluorescence, anastomotic perfusion, indocyanine greenAbstract
Indocyanine green fluorescence (ICG-F) for assessing anastomotic perfusion in intestinal surgery shows promising results, but evidence supporting its effectiveness in reducing anastomotic leaks is still scarce. The objective of this article was to analyze the effectiveness of ICG-F for assessing intestinal anastomotic perfusion and its relationship with treatment change and the incidence of anastomotic leak. A systematic review was conducted, with searches from databases such as PubMed, Scielo, Scopus, and TripDatabase. A search strategy was used based on Mesh/Decs terms and Boolean operators. A total of 4,248 articles were identified, 16 of which were selected and critically reviewed using the CASPe tool. A qualitative synthesis of the evidence was conducted using the PRISMA methodology. The 16 articles evaluated 3,621 adults, mostly men, with a mean age >60 years, undergoing colorectal surgery. F-IGC was used in 42.6%. Thirteen articles considered it feasible, safe, and efficient; it allows for modifications to initial treatment and reduces the incidence of anastomotic leaks. Three articles recognized it as an effective method, but no statistically significant differences were established with other methods in the incidence of anastomotic leak; however, modifications to the treatment plan were observed. F-IGC is a promising tool for assessing anastomotic perfusion in intestinal surgery. The need for clinical trials with homogeneous protocols was evident to confirm the clinical benefit and define standardized guidelines for use.
Downloads
References
Bonadio, L., Iacuzzo, C., Cosola, D., Cipolat Mis, T., Giudici, F., Casagranda, B., Biloslavo, A., & de Manzini, N. (2020). Indocyanine green-enhanced fluorangiography (ICG-Ff) in laparoscopic extraperitoneal rectal cancer resection. Updates in Surgery, 72(2), 477–482. https://doi.org/10.1007/S13304-020-00725-6/METRICS
Chan, D. K. H., Lee, S. K. F., & Ang, J. J. (2020). Indocyanine green fluorescence angiography decreases the risk of colorectal anastomotic leakage: Systematic review and meta-analysis. Surgery (United States), 168(6), 1128–1137. https://doi.org/10.1016/J.SURG.2020.08.024/ASSET/60E599E6-728C-4821-BAD2-DF4E1C766D86/MAIN.ASSETS/GR7.JPG
Chang, Y. K., Foo, C. C., Yip, J., Wei, R., Ng, K. K., Lo, O., Choi, H. K., & Law, W. L. (2019). The impact of indocyanine-green fluorescence angiogram on colorectal resection. The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 17(5), 270–276. https://doi.org/10.1016/J.SURGE.2018.08.006
Chen, H., Ye, L., Huang, C., Shi, Y., Lin, F., Ye, H., & Huang, Y. (2023). Indocyanine green angiography for lower incidence of anastomotic leakage after transanal total mesorectal excision: a propensity score-matched cohort study. Frontiers in Oncology, 13, 1134723. https://doi.org/10.3389/FONC.2023.1134723
De Simone, B., Abu-Zidan, F. M., Boni, L., Castillo, A. M. G., Cassinotti, E., Corradi, F., Di Maggio, F., Ashraf, H., Baiocchi, G. L., Tarasconi, A., Bonafede, M., Truong, H., De’Angelis, N., Diana, M., Coimbra, R., Balogh, Z. J., Chouillard, E., Coccolini, F., Kelly, M. D., … Catena, F. (2025). Indocyanine green fluorescence-guided surgery in the emergency setting: the WSES international consensus position paper. World Journal of Emergency Surgery: WJES, 20(1), 13. https://doi.org/10.1186/S13017-025-00575-W
Dinallo, A. M., Kolarsick, P., Boyan, W. P., Protyniak, B., James, A., Dressner, R. M., & Arvanitis, M. L. (2019). Does routine use of indocyanine green fluorescence angiography prevent anastomotic leaks? A retrospective cohort analysis. American Journal of Surgery, 218(1), 136–139. https://doi.org/10.1016/j.amjsurg.2018.10.027
Duan, Y., & Li, Y. (2020). P646 Utilisation of indocyanine green fluorescence imaging for Crohn’s disease following intestinal resection. Journal of Crohn’s and Colitis, 14(S1). https://doi.org/10.1093/ECCO-JCC/JJZ203.774
Elía-Guedea, M., Echazarreta-Gallego, E., Córdoba Díaz de Laspra, E., Pérez Tierra Ruiz, J., & Ramírez-Rodríguez, J. M. (2020). ¿Podemos prevenir la dehiscencia anastomótica en cirugía oncológica colorrectal mediante el empleo de la angiografía de fluorescencia con verde de indocianina? Revista de Cirugía, 72(3), 189–194. https://doi.org/10.35687/S2452-45492020003514
Faber, R. A., Tange, F. P., Galema, H. A., Zwaan, T. C., Holman, F. A., Peeters, K. C. M. J., Tanis, P. J., Verhoef, C., Burggraaf, J., Mieog, J. S. D., Hutteman, M., Keereweer, S., Vahrmeijer, A. L., van der Vorst, J. R., & Hilling, D. E. (2023). Quantification of indocyanine green near-infrared fluorescence bowel perfusion assessment in colorectal surgery. Surgical Endoscopy, 37(9), 6824–6833. https://doi.org/10.1007/S00464-023-10140-8/FIGURES/5
Hasegawa, H., Tsukada, Y., Wakabayashi, M., Nomura, S., Sasaki, T., Nishizawa, Y., Ikeda, K., Akimoto, T., & Ito, M. (2020). Impact of intraoperative indocyanine green fluorescence angiography on anastomotic leakage after laparoscopic sphincter-sparing surgery for malignant rectal tumors. International Journal of Colorectal Disease, 35(3), 471–480. https://doi.org/10.1007/S00384-019-03490-0/METRICS
Ishii, M., Hamabe, A., Okita, K., Nishidate, T., Okuya, K., Usui, A., Akizuki, E., Satoyoshi, T., & Takemasa, I. (2020). Efficacy of indocyanine green fluorescence angiography in preventing anastomotic leakage after laparoscopic colorectal cancer surgery. International Journal of Colorectal Disease, 35(2), 269–275. https://doi.org/10.1007/S00384-019-03482-0
Ishiyama, Y., Harada, T., Amiki, M., & Ito, S. (2022). Safety and effectiveness of indocyanine-green fluorescence imaging for evaluating non-occlusive mesenteric ischemia. Asian Journal of Surgery, 45(11), 2331–2333. https://doi.org/10.1016/J.ASJSUR.2022.05.033
Iwamoto, M., Ueda, K., & Kawamura, J. (2022). A Narrative Review of the Usefulness of Indocyanine Green Fluorescence Angiography for Perfusion Assessment in Colorectal Surgery. Cancers, 14(22), 5623. https://doi.org/10.3390/CANCERS14225623
Kang, C. Y., Halabi, W. J., Chaudhry, O. O., Nguyen, V., Pigazzi, A., Carmichael, J. C., Mills, S., & Stamos, M. J. (2013). Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surgery, 148(1), 65–71. https://doi.org/10.1001/2013.JAMASURG.2
Karampinis, I., Keese, M., Jakob, J., Stasiunaitis, V., Gerken, A., Attenberger, U., Post, S., Kienle, P., & Nowak, K. (2018). Indocyanine Green Tissue Angiography Can Reduce Extended Bowel Resections in Acute Mesenteric Ischemia. Journal of Gastrointestinal Surgery, 22(12), 2117–2124. https://doi.org/10.1007/S11605-018-3855-1
Kondo, A., Kumamoto, K., Asano, E., Feng, D., Kobara, H., & Okano, K. (2022). Indocyanine green fluorescence imaging during laparoscopic rectal cancer surgery could reduce the incidence of anastomotic leakage: a single institutional retrospective cohort study. World Journal of Surgical Oncology, 20(1), 397. https://doi.org/10.1186/S12957-022-02856-Z
Li, Z., Zhou, Y., Tian, G., Liu, Y., Jiang, Y., Li, X., & Song, M. (2021). Meta-Analysis on the Efficacy of Indocyanine Green Fluorescence Angiography for Reduction of Anastomotic Leakage After Rectal Cancer Surgery. The American Surgeon, 87(12), 1910–1919. https://doi.org/10.1177/0003134820982848
Limbu, Y., Pudasaini, P., Regmee, S., Acharya, B. P., Ghimire, R., Maharjan, D. K., & Thapa, P. B. (2023). Indocyanine green fluorescence imaging in gastrointestinal surgery. Journal of Kathmandu Medical College, 12(2), 80–86. https://doi.org/10.3126/JKMC.V12I2.45509
Maione, F., Manigrasso, M., Chini, A., Vertaldi, S., Anoldo, P., D’Amore, A., Marello, A., Sorrentino, C., Cantore, G., Maione, R., Gennarelli, N., D’Angelo, S., D’Alesio, N., De Simone, G., Servillo, G., Milone, M., & De Palma, G. D. (2022). The Role of Indocyanine Near-Infrared Fluorescence in Colorectal Surgery. Frontiers in Surgery, 9, 886478. https://doi.org/10.3389/FSURG.2022.886478/BIBTEX
Marquardt, C., Kalev, G., & Schiedeck, T. (2020). Intraoperative fluorescence angiography with indocyanine green: retrospective evaluation and detailed analysis of our single-center 5-year experience focused on colorectal surgery. Innovative Surgical Sciences, 5(1–2), 35-42. https://doi.org/10.1515/ISS-2020-0009
Neddermeyer, M., Kanngießer, V., Maurer, E., & Bartsch, D. K. (2022). Indocyanine Green Near-Infrared Fluoroangiography Is a Useful Tool in Reducing the Risk of Anastomotic Leakage Following Left Colectomy. Frontiers in Surgery, 9, 850256. https://doi.org/10.3389/FSURG.2022.850256
Ortiz de Elguea, J., Riojas-Garza, A., Chapa-Lobo, A., Rangel-Ríos, H., García-García, A., Quevedo-Fernández, E., & Salgado-Cruz, L. (2022). Angiografía por fluorescencia con verde de indocianina para cirugía de colon y recto. Primera serie reportada en México. Revista de Gastroenterología de México, 87(1), 29–34. https://doi.org/10.1016/J.RGMX.2020.09.005
Otero, A., De Lacy, F., Van Laarhoven, J., Martín, B., Valverde, S., Bravo, R., & Lacy, A. (2021). The impact of fluorescence angiography on anastomotic leak rate following transanal total mesorectal excision for rectal cancer: a comparative study. Surgical Endoscopy, 35(2), 754–762. https://doi.org/10.1007/S00464-020-07442-6/METRICS
PRISMA Statement. (2020). PRISMA. http://prisma-statement.org/
Red CASPE. (2025). Critical Appraisal Skills Programme Español. https://redcaspe.org/materiales/
Slooter, M. D., Mansvelders, M. S. E., Bloemen, P. R., Gisbertz, S. S., Bemelman, W. A., Tanis, P. J., Hompes, R., Van Berge Henegouwen, M. I., & De Bruin, D. M. (2021). Defining indocyanine green fluorescence to assess anastomotic perfusion during gastrointestinal surgery: systematic review. BJS Open, 5(2). https://doi.org/10.1093/BJSOPEN/ZRAA074
Su, H., Wu, H., Bao, M., Luo, S., Wang, X., Zhao, C., Liu, Q., Wang, X., Zhou, Z., & Zhou, H. (2020). Indocyanine green fluorescence imaging to assess bowel perfusion during totally laparoscopic surgery for colon cancer. BMC Surgery, 20(1), 102. https://doi.org/10.1186/S12893-020-00745-4
Tang, G., Du, D., Tao, J., & Wei, Z. (2022). Effect of Indocyanine Green Fluorescence Angiography on Anastomotic Leakage in Patients Undergoing Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials and Propensity-Score-Matched Studies. Frontiers in Surgery, 9, 815753. https://doi.org/10.3389/FSURG.2022.815753/FULL
Tsang, Y. P., Alex Leung, L. H., Lau, C., & Tang, C. (2020). Indocyanine green fluorescence angiography to evaluate anastomotic perfusion in colorectal surgery. International Journal of Colorectal Disease, 35(6), 1133–1139. https://doi.org/10.1007/S00384-020-03592-0/METRICS
Tueme-de la Peña, D., Salgado-Gamboa, E. A., Ortiz de Elguea-Lizárraga, J. I., Zambrano Lara, M., Rangel-Ríos, H. A., Chapa-Lobo, A. F., & Salgado-Cruz, L. E. (2024). Indocyanine green fluorescence angiography in colorectal surgery: A retrospective case-control analysis in Mexico. Revista de Gastroenterología de México (English Edition), 89(2), 186–193. https://doi.org/10.1016/J.RGMXEN.2023.02.003
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 María Emilia Willches-Encalada, Fernando Andrés Neira-Quezada, Daniela Salomé Neira-Quezada
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors who publish in Revista UGC agree to the following terms:
1. Copyright
Authors retain unrestricted copyright to their work. Authors grant the journal the right of first publication. To this end, they assign the journal non-exclusive exploitation rights (reproduction, distribution, public communication, and transformation). Authors may enter into additional agreements for the non-exclusive distribution of the version of the work published in the journal, provided that acknowledgment of its initial publication in this journal is given.
© The authors.
2. License
The articles are published in the journal under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0). The terms can be found at: https://creativecommons.org/licenses/by-nc-sa/4.0/deed.en
This license allows:
- Sharing: Copying and redistributing the material in any medium or format.
- Adapting: Remixing, transforming, and building upon the material.
Under the following terms:
- Attribution: You must give appropriate credit, provide a link to the license, and indicate if any changes were made. You may do this in any reasonable manner, but not in any way that suggests the licensor endorses or sponsors your use.
- NonCommercial: You may not use the material for commercial purposes.
- ShareAlike: If you remix, transform, or build upon the material, you must distribute your creation under the same license as the original work.
There are no additional restrictions. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
