Extrahepatic biliary tract visualization using near-infrared fluorescence imaging with indocyanine green: optimization of dose and dosing time

Qiangxing Chen; Rou Zhou; Jiefeng Weng; Yueyuan Lai; Hui Liu; Jiao Kuang; Shuai Zhang; Zhaofeng Wu; Wen Wang; Weili Gu

doi:10.1007/s00464-020-08058-6

Extrahepatic biliary tract visualization using near-infrared fluorescence imaging with indocyanine green: optimization of dose and dosing time

Surg Endosc. 2021 Oct;35(10):5573-5582. doi: 10.1007/s00464-020-08058-6. Epub 2020 Oct 7.

Authors

Qiangxing Chen^#¹, Rou Zhou^#², Jiefeng Weng¹, Yueyuan Lai¹, Hui Liu¹, Jiao Kuang¹, Shuai Zhang¹, Zhaofeng Wu¹, Wen Wang¹, Weili Gu³

Affiliations

¹ Department of Surgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, China.
² Department of Endocrine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, China.
³ Department of Surgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, China. weili139221@163.com.

^# Contributed equally.

Abstract

Background: The dose and dosing time of indocyanine green (ICG) vary among fluorescence cholangiography (FC) studies. The purpose of this prospective, randomized, exploratory clinical trial was to optimize the dose and dosing time of ICG.

Methods: PubMed was searched to determine the optimal dose. To optimize the dosing time of ICG, a clinical trial was designed with two parts. The first part included patients with T tubes for more than 1 month. After the patient was injected with ICG, bile was collected at 10 time points to explore the change and trends of bile fluorescence intensity (FI). In addition, the results of the first experiment were used to setup a randomized controlled trial (RCT) that aimed to find the optimal dosing timing for ICG injections for laparoscopic cholecystectomy (LC). During surgery, imaging data were collected for analysis.

Results: After performing a systematic review, the ICG injection dose for each patient in the clinical trial was 10 mg. Five patients were included in the first part of the study. Bile collected 8 h after ICG injection had a higher FI than bile collected at other time points (p < 0.05), and the FI of bile collected 20 h after ICG injection was nearly zero. In the second part of the experiment, 4 groups of patients (6 patients per group) were injected with 10 mg ICG at 8, 10, 12 and 14 h prior to surgery. The distribution of bile duct FI (p = 0.001), liver FI (p < 0.001), and common bile duct (CBD)-to-liver contrast (p = 0.001) were not the same in each group. Further analysis with the Bonferroni method revealed the following: (1) the FI of the CBD in the 8 h group was significantly different from that in the 14 h group (adjusted p < 0.001); (2) the liver FI of the 8 h group was higher than that of the 10 h group (adjusted p = 0.042) and the 14 h group (adjusted p < 0.001); and (3) the CBD-to-liver contrast of the 8 h group was lower than that of the 10 h group (adjusted p = 0.013) and the 14 h group (adjusted p = 0.001).

Conclusion: ICG FC enables the real-time identification of extrahepatic bile ducts. The optimal effect of FC can be achieved by performing 10 mg ICG injections 10 to 12 h prior to surgery.

Keywords: Fluorescence cholangiography; ICG; Indocyanine green; Laparoscopic cholecystectomy; Near-infrared.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Bile Ducts, Extrahepatic*
Biliary Tract*
Cholangiography
Cholecystectomy, Laparoscopic*
Humans
Indocyanine Green
Optical Imaging
Randomized Controlled Trials as Topic

Substances

Indocyanine Green