Delayed bleeding is one of the postoperative complications of gastric endoscopic submucosal dissection (ESD) [1]. The clipping of exposed blood vessels after ESD completion is effective in preventing delayed bleeding [2]
[3]. However, the exposed blood vessels are sometimes difficult to detect. Herein we report the effectiveness of a novel image-enhanced endoscopic technology called red dichromatic imaging (or dual red imaging) for detecting exposed blood vessels and preventing delayed bleeding after gastric ESD.
A 61-year-old man had a 25-mm 0-IIc lesion located in the middle gastric body. We performed ESD using esophagogastroduodenoscopy (GIF-H290 T with EVIS X1 video system; Olympus Medical Systems, Tokyo, Japan). After completion of ESD, the scope was changed to a GIF-EZ1500, and the ESD-induced ulcer was observed ([Fig. 1 a], [Video 1]). We switched the white light imaging to red dichromatic imaging and the exposed blood vessels were more clearly visualized ([Fig. 1 b], [Video 1]). A blood vessel penetrating the muscle layer was covered with submucosal fibrous and fatty tissue, as observed by white light ( [Fig.2 a]). This blood vessel could be identified more clearly than the surrounding tissue using red dichromatic imaging ([Fig. 2 b]). We were able to easily detect the exposed blood vessels using red dichromatic imaging and then perform clipping (HX-610-090S; Olympus Medical Systems) ([Fig. 3]). The patient was discharged without delayed bleeding.
Fig. 1 Endoscopic submucosal dissection (ESD)-induced ulcer. a Observed using white light. b Observed using red dichromatic imaging.
Video 1 The observation of the exposed blood vessels in a gastric ulcer induced by endoscopic submucosal dissection using red dichromatic imaging.
Fig. 2 a The blood vessel penetrating the muscle layer was covered with submucosal and fatty tissue, as observed by white light. b The blood vessel could be identified more clearly than the surrounding tissue using red dichromatic imaging.
Fig. 3 Endoscopic submucosal dissection-induced ulcer after clipping.
Red dichromatic imaging is a novel image-enhanced endoscopic technology using three wavelengths (540 nm, 600 nm, and 630 nm). Its effectiveness for detecting bleeding vessels has been previously reported [4]. In this case, submucosal fibrous tissue, fatty tissue, and the muscle layer were identified as a whiter collar using red dichromatic imaging rather than white light. Red dichromatic imaging helped gain a clear endoscopic view during colorectal ESD with submucosal fatty tissue [5]. We were able to easily detect the exposed blood vessels using red dichromatic imaging because the color difference between the exposed blood vessels and surrounding tissue was clear.
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