Functional capillary density in ischemic conditioning: implications for esophageal resection with the gastric conduit

Background Ischemia may lead to leakage at the esophagogastric anastomosis after esophagectomy. The aim of this study was to investigate time dependent changes of gastric microcirculation after ischemic conditioning. Methods Twenty male Lewis rats were used and analyzed in 3 study groups and 1 control group. Group 1 (n = 5) underwent ligation of the left gastric artery and intravital fluorescence microscopy (IVM) on day 0; group 2 (n = 5) underwent IVM at 28 days after ligation of the LGA; and group 3 (n = 5) underwent IVM at 56 days after ligation of the LGA. The controls (n = 5) underwent sham surgery and IVM at 28 days thereafter. IVM was used to analyze gastric microcirculation by means of functional capillary density. Results Ligation of the LGA immediately led to significant reduction of perfusion at the lesser (100.5 ± 3.1 μm/mm2 vs 220.4 ± 7.4 μm/mm2; P <.001) and greater curvatures (195.1 ± 7.9 μm/mm2 vs 234.1 ± 9.4 μm/mm2; P = .013). During 28 days, microcirculation at the lesser curve ameliorated (164.9 ± 12.8 μm/mm2) and reached normal values after 56 days (215.8 ± 7.4 μm/mm2). At the greater curve, microcirculation was improved during 4 (261.3 ± 8 μm/mm2 P = .039) and 8 weeks (317.9 ± 10.3 μm/mm2; P <.001 vs control). Conclusions Gastric microperfusion continuously improves after partial devascularization. The results support further clinical studies to optimize gastric ischemic conditioning in patients undergoing esophagectomy.