Perioperative Microcirculatory Changes Detected with Gastroscopy Assisted Laser Doppler Flowmetry and Visible Light Spectroscopy in Patients with Median Arcuate Ligament Syndrome
Open accessAbstract
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 (SO 2 76± 6), as compared to healthy individuals (SO 2 81± 4), p=0.02. An overall significant improvement in SO 2 after surgical decompression of the celiac artery was found (SO 2 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 SO 2 in patients with MALS as compared to control subjects with normal intestinal circulation. An improvement in SO 2 after laparoscopic decompression was found, supporting a possible ischemic etiology in our patient population. Keywords: mesenteric ischemia, functional test, endoscopy, vascular surgery, abdominal pain
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In two prospective cohort studies, normalisation of VLS or tonometry after CA release was associated with a long term benefit in 80-92% of cases.
“In two prospective cohort studies, normalisation of VLS or tonometry after CA release was associated with a long term benefit in 80 e 92% of cases.”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [104]
The Results (page not provided) report that 11 of 12 patients (92%) had symptom improvement at a median follow-up of 18 months, and that VLS-measured oxygen saturation improved in eight patients after celiac artery decompression. This paper describes one prospective cohort, not two, and does not report that normalization of VLS or tonometry predicted long-term benefit in 80–92% of cases. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 24 · Cited by 13
Research works printed but not linked: 19
- [1]Lipshutz B. A composite study of the coeliac axis artery. Ann Surg. 1917; 65(2): 159. doi: 10.1097/00000658-191702000-00006 17863663 PMC1426316 · DOI
- [2]Horton KM, Talamini MA, Fishman EK. Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics. 2005; 25(5): 1177– 1182. doi: 10.1148/rg.255055001 16160104 · DOI
- [3]Bjorck M, Koelemay M, Acosta S, et al. Editor’s choice - management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017; 53(4): 460– 510. doi: 10.1016/j.ejvs.2017.01.010 28359440 · DOI · Paper page
- [4]Kim EN, Lamb K, Relles D, Moudgill N, DiMuzio PJ, Eisenberg JA. Median arcuate ligament syndrome—review of this rare disease. JAMA Surg. 2016; 151(5): 471– 477. doi: 10.1001/jamasurg.2016.0002 26934394 · DOI
- [5]Bech FR. Celiac artery compression syndromes. Surg Clin North Am. 1997; 77(2): 409– 424. doi: 10.1016/S0039-6109(05)70558-2 9146722 · DOI
- [6]Weber JM, Boules M, Fong K, et al. Median arcuate ligament syndrome is not a vascular disease. Ann Vasc Surg. 2016; 30: 22– 27. doi: 10.1016/j.avsg.2015.07.013 26365109 · DOI
- [7]Early DS, Ben-Menachem T, Decker GA, et al. Appropriate use of GI endoscopy. Gastrointest Endosc. 2012; 75(6): 1127– 1131. doi: 10.1016/j.gie.2012.01.011 22624807 · DOI
- [8]Mensink PB, van Petersen AS, Kolkman JJ, Otte JA, Huisman AB, Geelkerken RH. Gastric exercise tonometry: the key investigation in patients with suspected celiac artery compression syndrome. J Vasc Surg. 2006; 44(2): 277– 281. doi: 10.1016/j.jvs.2006.03.038 16890853 · DOI · Paper page
- [9]Urbanavičius L, Pattyn P, Van de Putte D, Venskutonis D. How to assess intestinal viability during surgery: a review of techniques. World J Gastrointest Surg. 2011; 3(5): 59– 69. doi: 10.4240/wjgs.v3.i5.59 21666808 PMC3110878 · DOI · Paper page
- [11]Friedland S, Benaron D, Coogan S, Sze DY, Soetikno R. Diagnosis of chronic mesenteric ischemia by visible light spectroscopy during endoscopy. Gastrointest Endosc. 2007; 65(2): 294– 300. doi: 10.1016/j.gie.2006.05.007 17137857 · DOI
- [12]Fajer S, Cornateanu R, Ghinea R, Inbar R, Avital S. Laparoscopic repair of median arcuate ligament syndrome: a new approach. J Am Coll Surg. 2014; 219(6): e75– e78. doi: 10.1016/j.jamcollsurg.2014.08.009 25283743 · DOI
- [13]Jimenez JC, Harlander-Locke M, Dutson EP. Open and laparoscopic treatment of median arcuate ligament syndrome. J Vasc Surg. 2012; 56(3): 869– 873. doi: 10.1016/j.jvs.2012.04.057 22743019 · DOI · Paper page
- [15]Forst T, Hohberg C, Tarakci E, Forst S, Kann P, Pfützner A. Reliability of lightguide spectrophotometry (O2C) for the investigation of skin tissue microvascular blood flow tissue oxygenation supply in diabetic and nondiabetic subjects. J Dia Sci Tech. 2008;2(6):1151–1156 PMC2769807 19885305
- [16]Rabin R, Charro F. EQ-SD: a measure of health status from the EuroQol Group. Ann Med. 2001; 33(5): 337– 343. doi: 10.3109/07853890109002087 11491192 · DOI · Paper page
- [17]Kaufman M, Singh G, Das S, et al. Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterol. 2010; 44(2): 127– 134. doi: 10.1097/MCG.0b013e3181bb854d 19826273 · DOI
- [20]van Noord D, Kuipers EJ, Mensink PB. Single vessel abdominal arterial disease. Best Pract Res Clin Gastroenterol. 2009; 23(1): 49– 60. doi: 10.1016/j.bpg.2008.11.012 19258186 · DOI
- [21]El-Hayek KM, Titus J, Bui A, Mastracci T, Kroh M. Laparoscopic median arcuate ligament release: are we improving symptoms? J Am Coll Surg. 2013; 216(2): 272– 279. doi: 10.1016/j.jamcollsurg.2012.10.004 23177373 · DOI
- [22]Roayaie S, Jossart G, Gitlitz D, Lamparello P, Hollier L, Gagner M. Laparoscopic release of celiac artery compression syndrome facilitated by laparoscopic ultrasound scanning to confirm restoration of flow. J Vasc Surg. 2000; 32(4): 814– 817. doi: 10.1067/mva.2000.107574 11013046 · DOI
- [23]Cienfuegos JA, Estevez MG, Ruiz-Canela M, et al. Laparoscopic treatment of median arcuate ligament syndrome: analysis of long-term outcomes and predictive factors. J Gastrointest Surg. 2018; 22(4): 713– 721. doi: 10.1007/s11605-017-3635-3 29185149 · DOI
- Authors
- Berge, S. T., Safi, N., Medhus, A. W., Sundhagen, J. O., Hisdal, J., & Kazmi, S. S.
- Affiliations
- Oslo University Hospital (NO)
- University of Oslo (NO)
- Corresponding author
- Berge, Simen Tveten
- Venue
- Vascular Health and Risk Management
- Publisher
- Informa UK Limited
- Published
- 2020-08
- Volume
- Volume 16
- Pages
- 331-341
- ISSN
- 1176-6344 (ISSN-L)
- 1178-2048
- PMC
- PMC7493022
- OpenAlex
- W3047965049
- Cited by
- 13
- References
- 24
- Citations by year
- 2025: 3 · 2024: 2 · 2022: 5 · 2021: 3
- FWCI
- 1.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Vascular Health and Risk Management (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Surgery › Vascular anomalies and interventions
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Keywords
- median arcuate ligament syndrome, chronic mesenteric ischemia, microcirculation, laser Doppler flowmetry, visible spectroscopy, celiac artery compression, laparoscopic decompression, upper gastrointestinal endoscopy, health-related quality of life
- MeSH terms
- Median Arcuate Ligament Syndrome, Adult, Aged, Aged, 80 and over, Blood Flow Velocity, Celiac Artery, Duodenum, Female, Gastroscopy, Humans, Male, Mesenteric Vascular Occlusion, Microcirculation, Middle Aged, Laparoscopy, Predictive Value of Tests, Prospective Studies, Quality of Life, Spectrum Analysis, Splanchnic Circulation, Stomach, Time Factors, Case-Control Studies, Treatment Outcome, Laser-Doppler Flowmetry, Decompression, Surgical, Recovery of Function, Young Adult, Mesenteric Ischemia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
