ESR 1.4
Impact of selective digestive decontamination (SDD) on post-operative outcome in esophagectomy / Innovative fiber-based molecular fluorescence endoscopy in suspected lung infections

Project

After esophageal surgery, bacterial pulmonary infection is one of the largest determinants of post-operative complications (40% of the patients). The supervisors proved Selective Decontamination of the Digestive tract (SDD) to be effective in intensive care patients. Further there seems to be a positive effect on anastomotic leakage when using SDD peri-operatively in major gastrointestinal surgery. Yet, SDD has not been applied peri-operatively in the field of esophagectomy and its impact on post-operative recovery and complications such as pneumonia, and anastomotic dehiscence. ESR 1.4 will set up a multicenter randomised clinical trial of SDD in patients undergoing esophagectomy in The Netherlands.

In cooperation with the University of Edinburgh (www.proteus.ac.uk), ESR 1.4 will introduce innovative optical imaging by microendoscopy and targeted optical tracers in patients with the suspicion of pneumonia for the early detection of bacterial and fungal infections. A novel multiwavelength clinical molecular fluorescence endoscopy system for lung imaging is introduced, tested and evaluated in an explanted lung model of discarded donor lungs unsuitable for in-human lung transplantation, in combination with Good Manufacturing Practice (GMP) produced optical tracer for the detection of neutrophils and bacteria in lungs. Subsequently, patients with the suspicion of a pulmonary infection will be imaged by this fiber-based system in combination with a cocktail of both a neutrophil and bacteria specific fluorescent tracer.
ESR 1.4 will actively be involved in the translation and valorisation of these new diagnostic techniques in cooperation with Edinburgh Molecular Imaging (EMI) Ltd.

Supervisors

  • Prof. Anne Marie G.A. de Smet, MD PhD, intensivist. Department of Intensive Care
  • Prof. Gooitzen M. van Dam, MD PhD, oncological surgeon, PI Optical Molecular Imaging Groningen » Link. Department of Surgery, Nuclear Medicine and Molecular Imaging and Intensive Care » Link

Collaborations

University of Edinburgh, UK
Edinburgh Molecular Imaging (EMI) Ltd, UK.

Relevant publications

  1. Oostdijk EAN, Kesecioglu J, Schultz MJ, Visser CE, de Jonge E, van Essen EHR, et al. Effects of Decontamination of the Oropharynx and Intestinal Tract on Antibiotic Resistance in ICUs A Randomized Clinical Trial. JAMA – J Am Med Assoc. 2014 Oct 8;312(14):1429–37.
  2. de Smet AMGA, Kluytmans JAJW, Cooper BS, Mascini EM, Benus RFJ, van der Werf TS, et al. Decontamination of the Digestive Tract and Oropharynx in ICU Patients. N Engl J Med. 2009 Jan 1;360(1):20–31.
  3. Roos D, Dijksman LM, Oudemans-van Straaten HM, de Wit LT, Gouma DJ, Gerhards MF. Randomized clinical trial of perioperative selective decontamination of the digestive tract versus placebo in elective gastrointestinal surgery. Br J Surg [Internet]. 2011;98(10):1365–72.
  4. van Dam GM, Themelis G, Crane LMA, Harlaar NJ, Pleijhuis RG, Kelder W, et al. Intraoperative tumor-specific fluorescence imaging in ovarian cancer by folate receptor-alpha targeting. Nat Med. 2011 Oct;17(10):1315–U202.
  5. van Oosten M, Schäfer T, Gazendam JAC, Ohlsen K, Tsompanidou E, de Goffau MC, et al. Real-time in vivo imaging of invasive- and biomaterial-associated bacterial infections using fluorescently labelled vancomycin. Nat Commun. 2013 Oct 15;4.

Keywords

SDD, esophagectomy, fluorescence endoscopy, tracer