# Real-time bowel perfusion monitoring with FUJIFILM ELUXEO® VISION endoscopic imaging system in colorectal surgery

## TL;DR

A new endoscopic system measures real-time tissue oxygen levels at bowel anastomoses to help prevent surgical complications.

## Contribution

A novel quantitative method for assessing bowel perfusion using real-time oxygen saturation imaging without dye injection.

## Key findings

- Significant differences in tissue oxygen saturation were found between staple lines and healthy mucosa.
- No intraoperative complications or anastomotic leaks occurred in the study group.
- The system shows potential as a complementary tool to traditional endoscopic evaluation methods.

## Abstract

Anastomotic leak is a serious complication of bowel anastomosis, with multifactorial etiology. Thorough intraoperative evaluation of the anastomosis using white light endoscopy and leak tests is critical. Indocyanine green fluorescence angiography (ICG-FA) has emerged as a tool to assess bowel perfusion, but has limitations, including patient allergies and procedural complexity. The FUJIFILM ELUXEO® VISION Endoscopic Imaging System uses oxygen saturation imaging (OSI) to measure tissue oxygen saturation (StO2) in real time, without requiring dye injection. This study investigates a novel quantitative approach for assessing bowel perfusion endoscopically by evaluating StO2 at colon anastomoses.

The FUJIFILM VISION was used to obtain intraoperative mucosal StO2 measurements in 12 patients’ post-colon resection with anastomosis. Measurements were taken at four locations: proximal base, proximal staple line, distal staple line, and distal base. Two-tailed paired t tests were used to compare StO2 measurements at distant healthy mucosa (base) to the staple line, both proximal and distal to the anastomosis. Patients were followed longitudinally via chart review to monitor outcomes.

The average StO2 differences were + 12.58% (95% CI 1.96 – 23.19%) between the proximal base and proximal staple line and + 15.34% (95% CI 6.76 – 23.9%) between the distal base and distal staple line. Significant StO2 differences were observed between baseline normal mucosa and staple line adjacent mucosa (proximal: p = 0.025; distal: p = 0.003). No patients had intraoperative complications or developed anastomotic leaks during the study.

This study shows that the ELUXEO® VISION Endoscopic Imaging System is a potentially useful tool for providing quantitative data on tissue perfusion at and near anastomotic sites, complementing traditional white light endoscopy and leak tests. Larger prospective studies with long-term follow-up are needed to confirm the relationship between StO2 measurements and clinical outcomes such as anastomotic leaks and stricture.

The online version contains supplementary material available at 10.1007/s00464-025-12526-2.