Department of Endoscopy, Katsushika Medical Center, The Jikei University School of Medicine, 6-41-2 Katsushika-ku, Tokyo, 125-8506, Japan,
Gastric Cancer. 2014 Jan;17(1):116-21. doi: 10.1007/s10120-013-0231-4. Epub 2013 Feb 8.
Endoscopic submucosal dissection (ESD) for superficial gastric neoplasm is a curative method. The aim of this study was to detect potential nonbleeding visible vessels (NBVVs) by using an infrared imaging (IRI) system.
A total of 24 patients (25 lesions) were consecutively enrolled between March 2010 and December 2010. The day after ESD, endoscopist A (K.M.), who was blinded to the actual procedure of ESD, performed esophagogastroduodenoscopy (EGD) of the post-ESD ulcer base using the IRI system. Endoscopist A marked gray/blue points in the hard-copy images with the IRI system. After the first procedure, endoscopist B (Y.Y.), who was blinded to the results recorded by endoscopist A, performed a second EGD with white light endoscopy and administered water-jet pressure with the maximum level of an Olympus flushing pump onto the post-ESD ulcer base. This test can cause iatrogenic bleeding via application of pressure to NBVV in the post-ESD ulcer.
The IRI system detected 58 gray points and 71 blue points. The post-ESD ulcer was divided into the central area and the peripheral area. There were 14 gray points (24 %) in the central area and 44 gray points (76 %) in the peripheral area. There were 19 blue points (27 %) in the central area and 52 blue points (73 %) in the peripheral area. There was no significant difference when comparing the distribution of gray points and blue points. Bleeding occurred with a water-jet pressure in 11 of 58 gray points and in none of the blue points (P = 0.000478). Among the gray points, bleeding in response to a water-jet pressure occurred in 2 points in the central area and in 9 points in the peripheral area.
The IRI system detects visible vessels (VVs) that are in no need of coagulation as blue points, and VVs have a potential risk of bleeding as gray points.
内镜黏膜下剥离术（ESD）治疗胃黏膜浅层肿瘤是一种根治性方法。本研究旨在通过使用红外成像（IRI）系统检测潜在的非出血性可视血管（NBVV）。
2010 年 3 月至 2010 年 12 月期间，连续纳入 24 例（25 处病变）患者。ESD 后第 1 天，盲法行 ESD 实际操作的内镜医师 A（K.M.）使用 IRI 系统对 ESD 后溃疡基底行食管胃十二指肠镜检查（EGD）。内镜医师 A 在 IRI 系统的硬拷贝图像上标记灰色/蓝色点。首次检查后，盲法内镜医师 A 记录结果的内镜医师 B（Y.Y.）使用白光内镜和奥林巴斯冲洗泵的最大压力水平对 ESD 后溃疡基底行第二次 EGD，并施加水喷射压力。该试验可通过对 ESD 后溃疡中的 NBVV 施加压力导致医源性出血。
IRI 系统检测到 58 个灰色点和 71 个蓝色点。ESD 后溃疡分为中央区和周边区。中央区有 14 个灰色点（24%），周边区有 44 个灰色点（76%）。中央区有 19 个蓝色点（27%），周边区有 52 个蓝色点（73%）。灰色点和蓝色点的分布无显著差异。在 58 个灰色点中，有 11 个点在水喷射压力下出现出血，而在 71 个蓝色点中无一例出现出血（P=0.000478）。在灰色点中，在中央区的 2 个点和周边区的 9 个点出现水喷射压力下出血。
IRI 系统检测到不需要凝固的可视血管（VV）作为蓝色点，而有出血潜在风险的 VV 作为灰色点。
