Digestive Diseases and Sciences

, Volume 64, Issue 1, pp 224–231 | Cite as

Dual Red Imaging Maintains Clear Visibility During Colorectal Endoscopic Submucosal Dissection

  • Hidenori Tanaka
  • Shiro OkaEmail author
  • Shinji Tanaka
  • Kenta Matsumoto
  • Kazuki Boda
  • Ken Yamashita
  • Daiki Hirano
  • Kyoku Sumimoto
  • Yuzuru Tamaru
  • Yuki Ninomiya
  • Nana Hayashi
  • Kazuaki Chayama
Original Article



The endoscopic lens becomes clouded and its visibility reduces during colorectal endoscopic submucosal dissection (ESD), especially in cases with submucosal fatty tissue. Dual red imaging (DRI) is a novel image-enhanced endoscopic technique that improves endoscopic visibility.


This study aimed to evaluate the predictive factors of submucosal fatty tissue and the clinical usefulness of DRI in maintaining clear visibility during colorectal ESD.


The study participants included 586 consecutive patients with 645 colorectal tumors who underwent ESD between January 2014 and July 2017. First, the degree of submucosal fatty tissue was evaluated by reviewing recorded images, and the clinical characteristics of the patients and tumors related to severe submucosal fatty tissue were evaluated. Second, 34 tumors resected using DRI were propensity score-matched in a 1:1 ratio to other resected tumors using white light imaging (WLI), and the degree of endoscope lens cloudiness and clinical outcomes were evaluated.


The proportion of tumors located in the right side of the colon, body mass index (≥ 25, BMI), and hemoglobin A1c (≥ 6.5%, HbA1c) were significantly higher in patients with severe submucosal fatty tissue. The visibility in the DRI group was significantly better than in the WLI group. Treatment outcomes in the DRI group were as good as those in the WLI group.


Tumor location in the right side of the colon, BMI (≥ 25), and HbA1c (≥ 6.5%) are the predictive factors of severe submucosal fatty tissue. DRI is useful in maintaining clear visibility during colorectal ESD, especially with submucosal fatty tissue.


Dual red imaging Colorectal endoscopic submucosal dissection Submucosal fatty tissue Clear visibility Endoscope lens cloudiness 


Compliance with ethical standards

Conflict of interest

The endoscope (PCF-Y0044) equipped with DRI mode was provided by Olympus Corporation. However, there are no funding or other relationships that can be considered as conflicts of interest.

Supplementary material

10620_2018_5306_MOESM1_ESM.doc (7.1 mb)
Supplementary material 1 (DOC 7280 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Hidenori Tanaka
    • 1
  • Shiro Oka
    • 2
    Email author
  • Shinji Tanaka
    • 1
  • Kenta Matsumoto
    • 2
  • Kazuki Boda
    • 2
  • Ken Yamashita
    • 2
  • Daiki Hirano
    • 2
  • Kyoku Sumimoto
    • 2
  • Yuzuru Tamaru
    • 2
  • Yuki Ninomiya
    • 2
  • Nana Hayashi
    • 1
  • Kazuaki Chayama
    • 2
  1. 1.Department of EndoscopyHiroshima University HospitalHiroshimaJapan
  2. 2.Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan

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