Red dichromatic imaging enhances submucosal visibility during endoscopic submucosal dissection: a pilot study

Abstract Background and Aims: In 2020, Olympus Medical Systems Corporation introduced Red Dichromatic Imaging (RDI) as a novel image-enhanced endoscopy (IEE) technology. However, clinical evidence regarding its practical applications and the lesions where RDI is beneficial remains limited. Endoscopic submucosal dissection (ESD) is an essential therapeutic option for gastrointestinal tumors, yet achieving clear visualization of the dissecting layer remains a significant challenge. This study aimed to evaluate the efficacy of RDI in enhancing visualization of the dissecting layer during ESD. Methods: A total of 86 images from 43 gastrointestinal tumors (esophagus, stomach, duodenum, colon, and rectum) were evaluated by 8 endoscopists. The visibility of the dissecting layer was assessed using a scale ranging from -2 (poor) to 2 (excellent) under white light imaging (WLI) and RDI. Additionally, the color difference between the submucosal and muscular layers was analyzed using the International Commission on Illumination Lab* color space system. Results: RDI significantly improved the visibility of the dissecting layer compared to WLI. Moreover, RDI showed a significantly greater color difference between the submucosal and muscular layers than WLI. Conclusion: RDI enhances visualization during ESD by improving the visibility of the dissecting layer and increasing color differentiation compared to conventional WLI. These findings suggest that incorporating RDI into routine endoscopic practice could lead to more precise and efficient ESD procedures, ultimately improving patient outcomes.

Publikationsverlauf

Eingereicht: 31. Dezember 2024

Angenommen nach Revision: 04. April 2025

Accepted Manuscript online:
22. April 2025