Background: Anastomotic leakage and stricture formation remain an important surgical challenge after esophagectomy with gastric tube reconstruction for cancer of the esophagus. The perfusion of the anastomotic site at the proximal site of the gastric tube depends exclusively on the microcirculation, making it susceptible to hypoperfusion. We hypothesized that increasing the perfusion pressure would improve blood flow at the anastomotic site of the gastric tube. Methods: A gastric tube was reconstructed in 9 pigs. Laser speckle imaging and thermographic imaging were used to measure blood flow and temperature, respectively, at the base, medial part, future anastomotic site, and top of the gastric tube. Measurements were repeated at every stepwise increase of mean arterial blood pressure (MAP) from 50 to 110 mm Hg. Results: Besides MAP, global hemodynamics did not change throughout the experiment. The blood flow in the top of the gastric tube was significantly lower than the flow in the base and medial part of the gastric tube at all levels of MAP. Increasing MAP did not have a significant effect on blood flow at any location in the gastric tube. Distribution of temperature was similar to distribution of flow for the different locations. Increases in MAP did not change temperature values at any location of the gastric tube. CONCLUSION: Blood flow in the upper part of the gastric tube is decreased compared with more proximal sites. Gastric tissue blood flow does not increase with increased perfusion pressure. Therefore, it is not recommended to increase MAP to supranormal levels to increase anastomotic tissue blood flow and reduce postoperative complications.,
Anesthesia and Analgesia
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Erasmus MC: University Medical Center Rotterdam

Klijn, E, Niehof, S.P, de Jonge, J, Gommers, D.A.M.P.J, Ince, C, & van Bommel, J. (2010). The effect of perfusion pressure on gastric tissue blood flow in an experimental gastric tube model. Anesthesia and Analgesia, 110(2), 541–546. doi:10.1213/ANE.0b013e3181c84e33