Intestinal Perforation Clinical Trial
— IMAGINEOfficial title:
Indocyanine Green Fluorescence Angiography Mediated Assessment of Gastro-Intestinal Perfusion in Neonates
The goal of this clinical trial is to test the use of the SPY-PHI device for the purpose of ICG-mediated intestinal perfusion visualization during gastrointestinal surgery in neonates and young infants (<3 months old) undergoing surgery for NEC, atresia, SIP or malrotation. The main question[s] it aims to answer are: - Is ICG-FA feasible for intraoperative use in neonates and young infants undergoing laparotomy for NEC, atresia, SIP or malrotation? - Is ICG-FA is safe to use in neonates during surgery? Participants will undergo surgical care for their diseases within the standard of care. During laparotomy, the pediatric surgeon will assess bowel perfusion in two ways. First, by visual inspection (the conventional method). Second, the intestine will be analyzed with indocyanine green fluorescence angiography (ICG-FA) by means of the hand-held SPY-PHI camera. For this purpose, the patients will be administered ICG intravenously. Afterwards, the intestinal perfusion will be assessed by means of the SPY-PHI device in 5 to 10 minutes. Specifically, the feasibility and safety for use of ICG-FA in neonates undergoing laparotomy as treatment for necrotizing enterocolitis (NEC), atresia, spontaneous intestinal perforation (SIP) and malrotation will be investigated. If ICG-FA turns out to be feasible and safe for the population investigated in this study, a follow-up study will be conducted with the aim to explore the potential benefits of this technique on the postoperative outcome and intraoperative decision-making.
Status | Not yet recruiting |
Enrollment | 20 |
Est. completion date | August 2024 |
Est. primary completion date | August 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | N/A to 3 Months |
Eligibility | Inclusion Criteria: - Written informed consent is obtained by both patient's parents or legal guardians (as applicable); - Patient is a neonate (< 1 month of age) or young infant (<3 months of age); - Patient is suffering from necrotizing enterocolitis, atresia, malrotation or spontaneous intestinal perforation; - Patient requires laparotomy for management of the disease. Exclusion Criteria: - Patient is suffering from clinically significant (treatment necessary) hyperbilirubinemia; - Patient is suffering from thyroid or liver disease; - Patient is allergic to the active substance indocyanine green or sodium iodide or iodine; - Patient has abdominal wall defects; - Patient can be treated non-surgically; - During the preoperative multidisciplinary meeting with the team, including the pediatric anesthetist, patient is deemed not stable enough hemodynamically to perform the ICG-FU measurements - Patient is assessed unstable by operating team intraoperatively. |
Country | Name | City | State |
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n/a |
Lead Sponsor | Collaborator |
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University Medical Center Groningen | Stryker Endoscopy, UMC Utrecht |
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* Note: There are 17 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Feasibility of ICG-FA for intraoperative assessment of intestinal perfusion | a. Possibility for the researchers to assess intestinal perfusion based on the intraoperative ICG-FA images (clarity: yes/no); | 10 minutes intraoperatively (recording) | |
Primary | Feasibility of ICG-FA for intraoperative assessment of intestinal perfusion | b. Possibility for the researchers to point out a specific location for resection of the bowel based on visualization of perfusion in the ICG-FA images (interpretability: yes/no); | 10 minutes intraoperatively (recording) | |
Primary | Feasibility of ICG-FA for intraoperative assessment of intestinal perfusion | c. Comparison of the number of procedures in which it was a priori possible to perform ICG-FA imaging and the number of procedures in which the device was eventually used intraoperatively (applicability); | 10 minutes intraoperatively (recording) | |
Primary | Feasibility of ICG-FA for intraoperative assessment of intestinal perfusion | d. Interference with intraoperative Near Infrared Spectroscopy (NIRS) brain monitoring (compatibility: brain monitoring not interfered with/possible despite interference/impossible due to interference); | 10 minutes intraoperatively (recording) | |
Primary | Safety of intraoperative ICG-FA in gastrointestinal surgery for young infants and neonates | a. Number of complications directly related to use of the device or extension of operative time for ICG-FA imaging, occurring within 24 hours after surgery in the patients involved in this study; | 24 hours | |
Primary | Safety of intraoperative ICG-FA in gastrointestinal surgery for young infants and neonates | b. Measurement of the prolonged OR time associated with intraoperative ICG-FA in minutes; | 24 hours | |
Secondary | Comparison of conventional and ICG-FA mediated assessment | a. Comparing whether the perfusion assessment of ICG-FA can provide more certainty on the perfusion status of intestinal sections than conventional visual assessment (by comparing ICG-FA images with normal view images) in order to identify whether ICG-FA, if applied for decision-making, would have confirmed or altered intraoperative decision making. | Through study completion, on average within 4 weeks |
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