Surgical endoscopy
October 20, 2026 · via Europe PMC
Targeting indocyanine green where it matters most: a CRP-stratified cohort study in acute cholecystitis.
Carramiñana-Nuño R, Palacios-Gasós P, Lete-Aguirre N, Gasós-García M, Lagos-De Los Reyes Á, Fontana-Escartín S, Borrego-Estella VM.
AI summary — for doctors, generated from the abstract only
In acute cholecystitis, ICG fluorescence cholangiography appeared to help most in patients with high CRP, though the conversion benefit was not statistically confirmed.
What was studied
Prospective cohort of 221 emergency laparoscopic cholecystectomies (85 with ICG, 136 conventional) testing whether preoperative CRP modifies the effect of ICG on conversion and operative time.
Key findings
- Conversions occurred only without ICG (12/136, 8.8% vs 0/85), rising to 15.4% in the top CRP tertile
- Estimated absolute risk reduction 9.8 points (NNT about 10) in the middle tertile and 15.4 points (NNT 6.5) in the highest
- CRP by ICG interaction was significant for operative time (p = 0.045) but not for conversion (p = 0.878)
Clinical relevance
A cheap marker like CRP might help target ICG, which adds cost, to patients at highest risk of difficult surgery.
Who should care
Limitations
Non-randomized cohort with zero conversion events in the ICG arm, so the interaction on conversion was not estimable and the conversion finding is hypothesis-generating.
Consider prioritizing ICG for patients with high CRP while awaiting prospective testing of this strategy.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Intraoperative indocyanine green (ICG) fluorescence cholangiography has been linked to fewer conversions to open surgery in emergency cholecystectomy, but it adds cost, and evidence for its effect on conversion and operative time is graded moderate to low even by the consensus statement recommending routine use. We asked whether preoperative C-reactive protein (CRP), a marker of surgical difficulty and conversion risk, identifies patients in whom ICG's benefit is greatest.
Methods
Prospective cohort of 221 patients undergoing emergency laparoscopic cholecystectomy for acute cholecystitis, stratified by ICG use (85 ICG vs 136 conventional). We tested the interaction between CRP and ICG use on conversion using Firth penalized logistic regression, and on operative time, length of stay, and complications using linear/logistic regression with a log-CRP sensitivity analysis. We compared conversion rates across CRP tertiles and calculated a CRP-stratified estimated absolute risk reduction (ARR) and number needed to treat (NNT).
Results
Conversion occurred only in the conventional arm (12/136, 8.8%; 0/85 ICG), rising from 0 to 15.4% across CRP tertiles. The formal CRP×ICG interaction for conversion was not significant (Firth model, p = 0.878), reflecting the absence of ICG-arm events; the ARR associated with ICG use rose from not estimable to 9.8 points (95% CI 3.9-22.5; NNT≈10) in the middle tertile and 15.4 points (95% CI 8.0-27.5; NNT 6.5) in the highest. The interaction was significant for operative time (p = 0.045), strengthening under a log-CRP sensitivity model (p = 0.001), with CRP-related lengthening of surgery markedly smaller in the ICG arm.
Conclusions
In this cohort, ICG's clinical benefit was not uniform across the CRP range. The CRP×ICG interaction reached significance for operative time; for conversion, the pattern was consistent and clinically plausible but not statistically significant, and should be regarded as hypothesis-generating. A CRP-informed strategy for prioritising ICG may be worth testing prospectively.
DOI
10.1007/s00464-026-13524-8
PMID
42902004
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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