Clin Endosc.  2020 Jan;53(1):54-59. 10.5946/ce.2019.065.

Clinical Usefulness of Dual Red Imaging in Gastric Endoscopic Submucosal Dissection: A Pilot Study

• Yorita N
• Oka S
• Tanaka S
• Kotachi T
• Nagasaki N
• Hata K
• Kuroki K
• Masuda K
• Kurihara M
• Kiso M
• Boda T
• Ito M
• Chayama K

• KMID: 2500905
• DOI: http://doi.org/10.5946/ce.2019.065

Abstract

Background/Aims
Dual red imaging (DRI) is a new, image-enhanced endoscopy technique. There are few reports about the usefulness of DRI during gastric endoscopic submucosal dissection (ESD). We aimed to examine the usefulness of DRI in endoscopic hemostasis during gastric ESD.
Methods
We enrolled a total of 20 consecutive patients who underwent gastric ESD. Five endoscopists compared DRI with white light imaging (WLI) for the visibility of blood vessels and bleeding points while performing endoscopic hemostasis.
Results
The visibility of blood vessels was increased in 56% (19/34) of the cases, and the visibility of bleeding points was improved in 55% (11/20) of the cases with the use of DRI compared with the use of WLI.
Conclusions
DRI improved the visibility of blood vessels and bleeding points in cases with oozing bleeding, blood pooling around the bleeding points, and multiple bleeding points.

Keyword

Dual red imaging; Endoscopic submucosal dissection; Endoscopic hemostasis; Image-enhanced endoscopy; Gastrointestinal bleeding

Figure

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  Fig. 1. Representative cases showing the usefulness of dual red imaging (DRI) in improving the visibility of blood vessels. Images from white light imaging (WLI) (A, C) and their corresponding DRI images (B, D). DRI enhanced the color tone of arteries and veins and improved visibility.

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  Fig. 2. Representative cases showing the usefulness of dual red imaging (DRI) in improving the visibility of bleeding points. Images from white light imaging (WLI) (A, C) and their corresponding DRI images (B, D). DRI emphasized the blood flow from the bleeding points in orange color, which made it easier to accurately detect the bleeding points (yellow and blue arrows).

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  Fig. 3. Mechanism of the dual red imaging (DRI) system. (A) In low concentration of blood, most of the 600-nm wavelength (orange color) is not attenuated, whereas the same wavelength is attenuated in the presence of a high concentration of blood. (B) Because yellow light of 600 nm is attenuated more in high-concentrated blood than in low-concentrated blood, the reflected image becomes reddish and contrast occurs. DRI was used at the 2 different blood concentrations. (C) A small amount of high-density blood was injected backward into the low-concentrated blood. DRI can distinguish between the different concentrations of blood. HCB, high concentration blood; LCB, low concentration blood.

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