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Red dichromatic imaging reduces bleeding and hematoma during submucosal injection in esophageal endoscopic submucosal dissection

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Abstract

Background

Bleeding and hematoma formation during submucosal injection in esophageal endoscopic submucosal dissection (ESD) reduce the visibility of the submucosa. Red dichromatic imaging (RDI) is an endoscopic technique that provides better visualization of the deep submucosal blood vessels. We speculated that blood vessel injury could be avoided with RDI. This pilot study evaluated the role of RDI in preventing bleeding and hematoma formation during esophageal ESD.

Methods

This was a single-center retrospective observational study. We examined 60 patients who underwent ESD with white light imaging (WLI) and RDI. A single endoscopist reviewed all of the surgical videos to document the incidence and severity of bleeding episodes. Eighteen videos provided adequate quality and detail, and the number of blood vessels traversing the mucosal incision lines of the lesions in these videos was evaluated under WLI and RDI.

Results

The WLI group had a significantly higher incidence of hematomas per unit area compared to the RDI group (0.18/cm2 [range 0–0.38] vs. 0 [0–0.18]/cm2, p = 0.024). The WLI group also had a significantly higher incidence of total bleeding episodes compared to the RDI group (42.9% [range 21.7–60.4] vs 16.7% [range 13.8–22.9], p < 0.001). Significantly more blood vessels were visible under RDI compared to WLI (5 [range 4–8] vs. 2 [range 1–5], p = 0.0020).

Conclusion

RDI reduced the incidence of bleeding and hematoma formation during submucosal injection in esophageal ESD. It was assumed that the improvement of blood vessel visibility by RDI might have contributed to the result.

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Acknowledgements

The authors would like to thank editage for English language review.

Funding

Funding information is not available.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    Kurato Miyazaki, Motohiko Kato, Kentaro Iwata, Yoko Kubosawa, Yukie Hayashi, Mari Mizutani, Kaoru Takabayashi & Takanori Kanai

  2. Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Kurato Miyazaki, Motohiko Kato, Motoki Sasaki, Kentaro Iwata, Teppei Masunaga, Yoko Kubosawa, Mari Mizutani, Yoshiyuki Kiguchi, Yusaku Takatori, Noriko Matsuura, Atsushi Nakayama & Naohisa Yahagi

  3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saitama City Hospital, Saitama, Japan

    Makoto Mutaguchi

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  1. Kurato Miyazaki
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Corresponding author

Correspondence to Motohiko Kato.

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Disclosures

Mr. Motoki Sasaki and Drs. Kurato Miyazaki, Motohiko Kato, Kentaro Iwata, Teppei Masunaga, Yoko Kubosawa, Yukie Hayashi, Mari Mizutani, Yoshiyuki Kiguchi, Yusaku Takatori, Makoto Mutaguchi, Noriko Matsuura, Atsushi Nakayama, Kaoru Takabayashi, Takanori Kanai, and Naohisa Yahagi have no conflict of interest or financial ties to disclose.

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Miyazaki, K., Kato, M., Sasaki, M. et al. Red dichromatic imaging reduces bleeding and hematoma during submucosal injection in esophageal endoscopic submucosal dissection. Surg Endosc 36, 8076–8085 (2022). https://doi.org/10.1007/s00464-022-09244-4

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