Clinical impact of dual red imaging in colorectal endoscopic submucosal dissection: a pilot study

Abstract

Background: Dual red imaging (DRI), a novel image-enhanced endoscopic technique, is expected to improve visibility of thin vessels, but no reports of the clinical use of DRI in colorectal endoscopic submucosal dissection (ESD) have been published. We aimed to compare the visibility of vessels, demarcation line between the submucosal and muscle layers after injection of hyaluronate sodium with minute indigo carmine, and fibrosis on DRI with that on white light imaging (WLI). We applied the principle of DRI to the image of the submucosal layer during colorectal ESD as a pilot study. Methods: A total of seven physicians compared 17 DRI images to the corresponding WLI images in colorectal ESD. The physicians compared the number of arteries identified on DRI with the actual number of arteries. The physicians rated the visibility of vessels, the demarcation line between the submucosal and muscle layers after injection of hyaluronate sodium with minute indigo carmine, and fibrosis. Inter-observer agreement was also examined using the kappa statistic. Results: Visibility of vessels and the demarcation line between the submucosal and muscle layers after injection of hyaluronate sodium with minute indigo carmine improved with the use of DRI compared with that using WLI. DRI can discriminate between arteries and veins clearly through the color of the vessels. Conclusions: DRI improves the visibility of vessels, especially that of arteries, as they appear orange, and the demarcation line of the muscle layer. DRI may help to make colorectal ESD safer and faster.

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

“…We previously reported that DRI improved the visibility of arteries and the submucosal layer in colorectal ESD. 6 Because DRI makes hemostasis easier in many cases, DRI greatly improves the visibility of blood vessels. 6,14 The orange color of the bloodstream makes it easy to assess the bleeding point.…”

“…They scored the images from DRI relative to the corresponding images from WLI for visibility of blood vessels according to the following scale: +2 (improved visibility), +1 (slightly improved visibility), 0 (visibility equivalent to that of WLI), -1 (worsened visibility), and -2 (visibility lost) ( Table 1). 6,7 The total scores of the 5 endoscopists were calculated. In this study, the highest possible score was +10 and the lowest was -10.…”

“…A score ≥+5 was defined as improved; between +4 and -4, as equivalent; and ≤-5, as decreased, as previously reported. [6][7][8] Next, we investigated the clinicopathological features of…”

Utility of Dual Red Imaging for Endoscopic Hemostasis of Gastric Ulcer Bleeding

“…Naganuma et al [2] reported that DRI was useful to assess the severity of inflammation using the deep vascular pattern in patients with ulcerative colitis. Ninomiya et al [3] proposed that DRI may enhance both the safety and speed of colorectal endoscopic submucosal dissection by improving the visibility of the arteries. Furuichi et al [4] similarly found that DRI increased the visibility of the esophageal varices and red color sign.…”

The Role of Dual Red Imaging in Gastric Endoscopic Submucosal Dissection

“…The displayed image shows that the 600 nm light is significantly more attenuated than the 630 nm light, which enhances the visibility of the deep vessels. 5 When blood vessels are absent, the reflected light is visualized with low attenuation; however, the reflected 600 nm light becomes highly attenuated in the presence of highly concentrated blood when compared to the presence of low-concentrated blood. Thus, the reflected image becomes reddish with the concomitant occurrence of a color contrast.…”