Scanning laser Doppler flowmetry and intraluminal recirculating gas tonometry in the assessment of gastric and jejunal perfusion during oesophageal resection

Abstract

Abstract Background The ability of the new techniques of scanning laser Doppler flowmetry and recirculating gas tonometry to measure changes in gastric serosal and mucosal blood flow respectively during oesophageal resection was assessed. Methods Changes in regional and total gastric blood flow were assessed in 16 patients undergoing oesophagectomy at three stages of the procedure. Laser Doppler images were analysed and perfusion expressed as mean perfusion units. Tonometric measurements of gastric and jejunal intramucosal pH (pHi) were made synchronously. Results There were significant falls in gastric perfusion measured with scanning laser Doppler flowmetry in all subjects between each measurement. Mean perfusion of the stomach fell 41 per cent after mobilization. There was a gradient of reduced perfusion between the antrum (mean fall 25 per cent) and the area used for the anastomosis in the fundus (mean fall 55 per cent). Before mobilization mean gastric and jejunal pHi were 7·37 and 7·46 respectively. These fell to 7·18 and 7·37 respectively after mobilization and to 7·29 and 7·38 after anastomosis. Conclusion These new techniques could be employed at operation, appear to overcome the limitations of single-point laser Doppler flowmetry and saline tonometry, and have measured significant changes in gastric perfusion. They may have widespread clinical application.