Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan.
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan; Department of Gastroenterology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.
Gastrointest Endosc. 2020 Sep;92(3):667-674. doi: 10.1016/j.gie.2020.05.033. Epub 2020 Jun 1.
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.
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.
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.
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.).
内镜黏膜下剥离术（ESD）过程中的止血有时会给内镜医生带来挑战和压力。因此，我们旨在评估双红成像（DRI）的有效性，这是一种新的图像增强技术，使用 3 个波长（540、600 和 630nm）来可视化出血点，并研究 DRI 在缩短 ESD 过程中止血所需时间（止血时间）方面的效果。
在 97 名接受 ESD 的患者中，我们交替使用 DRI 和白光成像（WLI）来处理 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，4 名经验丰富的内镜医生观看了 ESD 术中出血的随机视频（每个 WLI 和 DRI 各 20 例），并在每个视频中识别出血点。比较每个视频中识别出血点前的眼动单位时间平均距离，并比较 WLI 和 DRI 组之间的差异。
DRI 组的平均止血时间明显缩短。对于所有内镜医生，DRI 组的眼动平均距离明显短于 WLI 组。
DRI 可以提供有用的图像，有助于更清晰地检测出血点，并在 ESD 过程中促进止血。它是可行的，可能有助于安全、快速地完成比 WLI 更快的 ESD。（临床试验注册号：UMIN000018309.）。
