Perioperative Microcirculatory Changes Detected with Gastroscopy Assisted Laser Doppler Flowmetry and Visible Light Spectroscopy in Patients with Median Arcuate Ligament Syndrome

Abstract

Purpose

Physiological tests may aid in diagnosing median arcuate ligament syndrome (MALS). MALS is a symptomatic compression of the celiac artery causing symptoms similar to chronic mesenteric ischemia (CMI) of atherosclerotic etiology. Simultaneous use of visible light spectroscopy (VLS) and laser doppler flowmetry (LDF) during upper endoscopy may detect microcirculatory changes in these patients.

Patients and Methods

In a single-center, prospective comparative cohort, 25 patients were evaluated for MALS. Patients with a consensus diagnosis of MALS (n=15) underwent a gastroscopy assisted, transmucosal microcirculatory assessment with LDF and VLS. Results were compared to individuals with normal intestinal circulation (n=38) evaluated with duplex ultrasonography, and to patients with chronic mesenteric ischemia (n=32). Treatment response was evaluated clinically at 1, 3, 6, and 12 months, and with ultrasound, VLS and LDF at three months. Health-related quality of life (QoL) was assessed with Euroqol (EQ-5D-5L), preoperatively, and 12 months postoperatively.

Results

Preoperative mean transmucosal oxygen saturation was significantly lower in patients with MALS (SO₂ 76±6), as compared to healthy individuals (SO₂ 81±4), p=0.02. An overall significant improvement in SO₂ after surgical decompression of the celiac artery was found (SO₂ 81±3.7, p=0.05). Eleven (92%) patients with clinical improvement after laparoscopic decompression had a definitive diagnosis of MALS. Median follow-up was 18 months (4–24 months). Four of the five dimensions investigated with EQ-5D-5L improved.

Conclusion

VLS detected a significantly lower baseline transmucosal SO₂ in patients with MALS as compared to control subjects with normal intestinal circulation. An improvement in SO₂ after laparoscopic decompression was found, supporting a possible ischemic etiology in our patient population.

Keywords:

• mesenteric ischemia
• functional test
• endoscopy
• vascular surgery
• abdominal pain

Data Sharing Statement

Individual participant data that underlie the results reported in this article, after deidentification (text, tables and figures), will be made available at the conclusion of the ongoing study on chronic mesenteric ischemia at Oslo University Hospital, in 2022 and be available for three years. In addition to this, the study protocol will be available. Data will be shared with investigators whose proposed use of the data has been approved by an independent review committee identified for this purpose. Proposals should be directed to M.D. PhD Syed Sajid Hussain Kazmi, [email protected], project leader. To gain access, data requestors will need to sign a data access agreement.

Author Contributions

All authors, STB, NS, AWM, JOS, JH, and SSHK made a substantial contribution to conception and design, acquisition of data, analysis, and interpretation of data; took part in drafting the article and revising it critically. All authors gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.