Background and Aims

Hemostasis during endoscopic submucosal dissection (ESD) can sometimes be challenging and stressful for the endoscopist. Therefore, we aimed to assess the usefulness of dual red imaging (DRI), a new image enhancement technique that uses 3 wavelengths (540, 600, and 630 nm) to visualize bleeding points and to examine the efficacy of DRI in shortening the time required to achieve hemostasis (hemostasis time) during ESD.

Methods

DRI and white-light imaging (WLI) were used alternately for managing 378 bleeding events in 97 patients undergoing ESD. Hemostasis time for each hemostasis event was measured. Using portable eye-tracking glasses, 4 experienced endoscopists were shown random videos of intraoperative bleeding during ESD (20 cases each on WLI and DRI) and identified the bleeding point in each video. The mean distances of eye movement per unit of time until the bleeding point were identified in each video and compared between the WLI and DRI groups.

Results

Average hemostasis time was significantly shorter in the DRI group. The mean distance of eye movement was significantly shorter in the DRI group than in the WLI group for all endoscopists.

Conclusions

DRI can offer useful images to help in clearly detecting bleeding points and in facilitating hemostasis during ESD. It is feasible and may help in successfully performing ESD that is safer and faster than WLI. (Clinical trial registration number: UMIN000018309.)

中文翻译：

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一种新的图像增强技术在内窥镜黏膜下剥离中实现止血的功效。

背景和目标

对于内镜医师而言，在内镜下黏膜下剥离术（ESD）期间的止血有时可能具有挑战性和压力。因此，我们旨在评估双红色成像（DRI）的实用性，这是一种使用3个波长（540、600和630 nm）可视化出血点并检查DRI在缩短所需时间方面的功效的新图像增强技术。在ESD期间达到止血（止血时间）的目的。

方法

交替使用DRI和白光成像（WLI）处理97名接受ESD治疗的患者的378次出血事件。测量每个止血事件的止血时间。使用便携式眼动跟踪眼镜，向4位经验丰富的内镜医师展示了ESD术中出血的随机视频（在WLI和DRI上各20例），并在每个视频中确定了出血点。在每个视频中确定了每单位时间直到出血点的平均眼球运动距离，并在WLI和DRI组之间进行了比较。

结果

DRI组的平均止血时间明显缩短。对于所有内镜医师，DRI组的平均眼球运动距离明显短于WLI组。

结论

DRI可以提供有用的图像，以帮助明确检测出血点并促进ESD期间的止血。这是可行的，并且可能有助于成功执行比WLI更安全，更快速的ESD。（临床试验注册号：UMIN000018309。）