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Tracheo-Esophageal Fistula with Atresia of EsophagusiTOFNCT05735964

Use of Indocyanine Green During Primary Repair of Oesophageal Atresia and Distal Tracheo-oesophageal Fistula

A study testing Indocyanine green in people with Tracheo-Esophageal Fistula with Atresia of Esophagus, run by Birmingham Women's and Children's NHS Foundation Trust at 1 site in United Kingdom.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This study aims to look at babies having a primary or delayed primary oesophageal repair for OA with dTOF to evaluate if using Indocyanine green (ICG) and near infrared fluorescence (NIRF) can decrease the rates of anastomotic leaks and/or predict which patients they will happen in. Read more about this study

Who is it for?
Ages Up to 1 year
What is being tested?
Indocyanine green
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
20 participants
Where
1 siteUnited Kingdom
Study dates
1 Mar 2023to Mar 2026
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Up to 1 year
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Pre-operative
  • Diagnosis of oesophageal atresia with distal trachea-oesophageal fistula (OA/dTOF)
  • Plan for primary or delayed primary oesophageal anastomosis
  • Intra-operative
  • Diagnosis of OA/dTOF confirmed by standard methods
  • Primary or delayed primary oesophageal anastomosis considered clinically, physiologically, and technically feasible

Who cannot join

  • Pre-operative
  • Under 2.5kg in weight
  • Complex cardiac disease
  • Allergic to ICG
  • Allergic to iodine or iodides
  • Hyperthyroidism
Show all 11Show fewer
  • Chronic Kidney Disease stage V
  • Unwilling to participate
  • Those in whom exchange transfusion is indicated due to hyperbilirubinemia
  • Intra-operative
  • Anaesthetic concerns contra-indicating the use of intravenous ICG due its temporary effect on oxygen saturation readings prior to injection of ICG

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site, 1 recruiting
  • Birmingham children's hospital

    Birmingham, B4 6NH

    Max Pachl

    Recruiting

Other trials in United Kingdom

About this study

Official title: Indocyanine Green (ICG) and Near Infrared Fluorescence (NIRF) Guided Assessment of the Bowel and Oesophageal Anastomosis During Repair of Oesophageal Atresia with Distal Trachea-oesophageal Fistula (OA/dTOF): a Cohort Pilot Study

This study aims to look at babies having a primary or delayed primary oesophageal repair for OA with dTOF to evaluate if using Indocyanine green (ICG) and near infrared fluorescence (NIRF) can decrease the rates of anastomotic leaks and/or predict which patients they will happen in. The latter evaluation would help counsel parents and mean that further research can evaluate if other tactics can prevent the leak being a moderate or severe problem. These may include, but not be limited to, extra anastomotic sutures, insertion of a chest drain at the time of surgery (if this had not previously been considered) delaying oral feeding or using medications to dry up the saliva prophylactically (these medications have been shown to reduce the length of time it takes leaks to seal). Any technique that can reduce leak rates in oesophageal atresia is to be welcomed.

Additionally ICG may artifactually affect both peripheral oxygen readings (cause a transient decrease) and cerebral near infrared spectroscopy (NIRS) values (cause a transient increase). This is due to the temporary, dose dependent, interference of the dye with the mechanism of action of the monitoring rather than a physiological effect on oxygen levels. To date there has been no study investigating the effects of ICG on oxygen saturation and cerebral NIRS in neonates undergoing OA and/or dTOF repair.

Read more

The theory is an extension from adult practice following oesophagectomy for cancer where there was a reduction in anastomotic leaks when using ICG/NIRF perfusion assessment. Another study in bariatric surgery using an enteral ICG/NIRF assessment was highly sensitive for anastomotic leaks allowing management of them intra-operatively.

Objectives are to

  1. Identify if the appearances of ICG/NIRF can predict anastomotic leaks
  2. Identify if the ICG/NIRF images would engender a change in operative management leading to a reduced leak rate
  3. Give a detailed report on the effects of ICG on oxygen readings This would be a cohort pilot study of 20 patients with the aim of informing a subsequent multi-centre Randomised controlled trial
Read the detailed description

Anastomotic leaks can have wide ranging consequences. If they can be predicted and/or prevented clinical outcomes for patients would be improved along with shorter length of stay and reduced cost to the national health service (NHS) in the short, medium, and long term. These patients would require less bed days both on inpatient wards and paediatric intensive care units enabling the management of other children.

This study will evaluate if ICG/NIRF tissue perfusion diagnostics can show if the fistula (distal oesophagus) end is ischaemic (has poor blood flow) prior to anastomosis. Ischaemic ends are well recognised to relate to leakage although in OA the role of mucosal apposition is poorly understood. This intervention would afford the operator the opportunity to perform a fully vascularised join if feasible and also indicate if ischaemia predicts anastomotic leaks.

It will also evaluate if post-anastomosis intravenous and enteral dosing of ICG with NIRF assessment is able to predict those who will suffer from a leak whether that be clinical or radiological.

There is little data on the effect of ICG on peripheral oxygen saturation readings, or of its effect on near infrared spectroscopy readings in neonates. This study will record the effects on peripheral saturation and near-infrared spectroscopy readings which are used routinely in babies having this type of surgery. It will compare these readings to arterial blood oxygenation readings from a blood gas analyser. Blood gases are routinely taken during this procedure and so this will not involve any extra blood testing over and above what is ordinarily performed.

Being tested
Indocyanine green
Medical subject headings
Esophageal atresia with or without tracheoesophageal fistula

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Indocyanine greenDrug

    Intravenous and endoluminal dosing

Study groups in NCT05735964
Study groupRoleWhat they receive
ICGExperimentalPatients in this single arm will receive ICG during their surgery
Receives: Drug: Indocyanine green

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Intravenous ICG

    Number of patients with abnormal perfusion will have a clinical and/or radiological anastomotic leak

    Measured: Within two weeks of surgery

  2. Enteral ICG

    Number of patients in whom ICG given enterally shows an anastomotic leak

    Measured: Within two weeks of surgery

Secondary outcomes (2)
  1. Delphi

    Number of patients in whom ICG given prior to anastomosis causes a change in intra-operative plan

    Measured: Within a year following surgery

  2. Peripheral oxygen saturations (SpO2)

    In how many patients does the intravenous injection of ICG alter the peripheral oxygenation and/or near infrared spectroscopy readings.

    Measured: Within a year following surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Feb 2023
  2. Study start1 Mar 2023
  3. Primary completionMar 2026 (estimated)
  4. Study completionMar 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Not applicable
Intervention model
Single group
Model description
Consecutive patients
Masking
None (open label)
Enrolment
20 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05735964
Sponsor's protocol ID
22/BC/ONC/NO/633
Acronym
iTOF
Status last verified
Aug 2024
First submitted
20 Dec 2022
Last updated
4 Mar 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: data used in publications will be shared in peer-reviewed literature

Publications

  • Kalmar CL, Reed CM, Peery CL, Salzberg AD. Intraluminal indocyanine green for intraoperative staple line leak testing in bariatric surgery. Surg Endosc. 2020 Sep;34(9):4194-4199. doi: 10.1007/s00464-020-07606-4. Epub 2020 May 8.

    PubMed 32385707
  • Schmedding A, Wittekindt B, Schloesser R, Hutter M, Rolle U. Outcome of esophageal atresia in Germany. Dis Esophagus. 2021 Apr 7;34(4):doaa093. doi: 10.1093/dote/doaa093.

    PubMed 32995846
  • Long AM, Tyraskis A, Allin B, Burge DM, Knight M. Oesophageal atresia with no distal tracheoesophageal fistula: Management and outcomes from a population-based cohort. J Pediatr Surg. 2017 Feb;52(2):226-230. doi: 10.1016/j.jpedsurg.2016.11.008. Epub 2016 Nov 13.

    PubMed 27894760
  • Burge DM, Shah K, Spark P, Shenker N, Pierce M, Kurinczuk JJ, Draper ES, Johnson PR, Knight M; British Association of Paediatric Surgeons Congenital Anomalies Surveillance System (BAPS-CASS). Contemporary management and outcomes for infants born with oesophageal atresia. Br J Surg. 2013 Mar;100(4):515-21. doi: 10.1002/bjs.9019. Epub 2013 Jan 18.

    PubMed 23334932
  • Allin B, Knight M, Johnson P, Burge D; BAPS-CASS. Outcomes at one-year post anastomosis from a national cohort of infants with oesophageal atresia. PLoS One. 2014 Aug 25;9(8):e106149. doi: 10.1371/journal.pone.0106149. eCollection 2014.

    PubMed 25153838
  • Comella A, Tan Tanny SP, Hutson JM, Omari TI, Teague WJ, Nataraja RM, King SK. Esophageal morbidity in patients following repair of esophageal atresia: A systematic review. J Pediatr Surg. 2021 Sep;56(9):1555-1563. doi: 10.1016/j.jpedsurg.2020.09.010. Epub 2020 Sep 19.

    PubMed 33051081
  • Weber F, Scoones GP. A practical approach to cerebral near-infrared spectroscopy (NIRS) directed hemodynamic management in noncardiac pediatric anesthesia. Paediatr Anaesth. 2019 Oct;29(10):993-1001. doi: 10.1111/pan.13726. Epub 2019 Aug 29.

    PubMed 31437328
  • Bishay M, Giacomello L, Retrosi G, Thyoka M, Nah SA, McHoney M, De Coppi P, Brierley J, Scuplak S, Kiely EM, Curry JI, Drake DP, Cross KM, Eaton S, Pierro A. Decreased cerebral oxygen saturation during thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia in infants. J Pediatr Surg. 2011 Jan;46(1):47-51. doi: 10.1016/j.jpedsurg.2010.09.062.

    PubMed 21238638
  • Stolwijk LJ, van der Zee DC, Tytgat S, van der Werff D, Benders MJNL, van Herwaarden MYA, Lemmers PMA. Brain Oxygenation During Thoracoscopic Repair of Long Gap Esophageal Atresia. World J Surg. 2017 May;41(5):1384-1392. doi: 10.1007/s00268-016-3853-y.

    PubMed 28058473
  • Baek HY, Lee HJ, Kim JM, Cho SY, Jeong S, Yoo KY. Effects of intravenously administered indocyanine green on near-infrared cerebral oximetry and pulse oximetry readings. Korean J Anesthesiol. 2015 Apr;68(2):122-7. doi: 10.4097/kjae.2015.68.2.122. Epub 2015 Mar 30.

    PubMed 25844129
  • De Gasperi A, Mazza E, Prosperi M. Indocyanine green kinetics to assess liver function: Ready for a clinical dynamic assessment in major liver surgery? World J Hepatol. 2016 Mar 8;8(7):355-67. doi: 10.4254/wjh.v8.i7.355.

    PubMed 26981173
  • Kulshrestha S, Kulshrestha M, Tewari V, Chaturvedi N, Goyal A, Sharma RK, Sarkar D, Tandon JN, Katyal V. Conservative Management of Major Anastomotic Leaks Occurring after Primary Repair in Esophageal Atresia with Fistula: Role of Extrapleural Approach. J Indian Assoc Pediatr Surg. 2020 May-Jun;25(3):155-162. doi: 10.4103/jiaps.JIAPS_73_19. Epub 2020 Apr 11.

    PubMed 32581443
  • Cui X, He Y, Chen L, Lin Y, Zhang J, Zhou C. The Value of Thoracic Lavage in the Treatment of Anastomotic Leakage After Surgery for Type III Esophageal Atresia. Med Sci Monit. 2020 Mar 11;26:e919962. doi: 10.12659/MSM.919962.

    PubMed 32158013
  • Campos J, Tan Tanny SP, Kuyruk S, Sekaran P, Hawley A, Brooks JA, Bekhit E, Hutson JM, Crameri J, McLeod E, Teague WJ, King SK. The burden of esophageal dilatations following repair of esophageal atresia. J Pediatr Surg. 2020 Nov;55(11):2329-2334. doi: 10.1016/j.jpedsurg.2020.02.018. Epub 2020 Feb 19.

    PubMed 32143903
  • Donoso F, Hedenstrom H, Malinovschi A, E Lilja H. Pulmonary function in children and adolescents after esophageal atresia repair. Pediatr Pulmonol. 2020 Jan;55(1):206-213. doi: 10.1002/ppul.24517. Epub 2019 Sep 18.

    PubMed 31535483

Questions about this trial

What is this clinical trial studying?

A study testing Indocyanine green in people with Tracheo-Esophageal Fistula with Atresia of Esophagus, run by Birmingham Women's and Children's NHS Foundation Trust at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 4 Mar 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact max pachl (01213339999, max.pachl@nhs.net), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Intravenous ICG (time frame: Within two weeks of surgery). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05735964, which also lists 20 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Mar 2025.

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