Red dichromatic imaging reduces bleeding and hematoma during submucosal injection in esophageal endoscopic submucosal dissection

• Published in: Surgical endoscopy Vol. 36; no. 11; pp. 8076 - 8085
• Main Authors: Miyazaki, Kurato, Kato, Motohiko, Sasaki, Motoki, Iwata, Kentaro, Masunaga, Teppei, Kubosawa, Yoko, Hayashi, Yukie, Mizutani, Mari, Kiguchi, Yoshiyuki, Takatori, Yusaku, Mutaguchi, Makoto, Matsuura, Noriko, Nakayama, Atsushi, Takabayashi, Kaoru, Kanai, Takanori, Yahagi, Naohisa
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2022; Springer Nature B.V
• Subjects: Abdominal Surgery; Blood vessels; Endoscopic Mucosal Resection - adverse effects; Endoscopic Mucosal Resection - methods; Endoscopy; Esophageal Neoplasms - surgery; Esophagus; Esophagus - surgery; Gastroenterology; Gynecology; Hematoma; Hematoma - epidemiology; Hematoma - etiology; Hematoma - prevention & control; Hepatology; Humans; Medicine; Medicine & Public Health; Pilot Projects; Proctology; Retrospective Studies; Surgery; Treatment Outcome; Endoscopic submucosal dissection; Injection; Bleeding; Hematoma; Esophagus; Red dichromatic imaging
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-022-09244-4

Background Bleeding and hematoma formation during submucosal injection in esophageal endoscopic submucosal dissection (ESD) reduce the visibility of the submucosa. Red dichromatic imaging (RDI) is an endoscopic technique that provides better visualization of the deep submucosal blood vessels. We speculated that blood vessel injury could be avoided with RDI. This pilot study evaluated the role of RDI in preventing bleeding and hematoma formation during esophageal ESD. Methods This was a single-center retrospective observational study. We examined 60 patients who underwent ESD with white light imaging (WLI) and RDI. A single endoscopist reviewed all of the surgical videos to document the incidence and severity of bleeding episodes. Eighteen videos provided adequate quality and detail, and the number of blood vessels traversing the mucosal incision lines of the lesions in these videos was evaluated under WLI and RDI. Results The WLI group had a significantly higher incidence of hematomas per unit area compared to the RDI group (0.18/cm 2 [range 0–0.38] vs. 0 [0–0.18]/cm 2 , p  = 0.024). The WLI group also had a significantly higher incidence of total bleeding episodes compared to the RDI group (42.9% [range 21.7–60.4] vs 16.7% [range 13.8–22.9], p  < 0.001). Significantly more blood vessels were visible under RDI compared to WLI (5 [range 4–8] vs. 2 [range 1–5], p  = 0.0020). Conclusion RDI reduced the incidence of bleeding and hematoma formation during submucosal injection in esophageal ESD. It was assumed that the improvement of blood vessel visibility by RDI might have contributed to the result.