Makiguchi Mai, Abe Seiichiro, Fujimoto Ai, Kawagoe Ryosuke, Uozumi Takeshi, Kusuhara Mitsunori, Mizuguchi Yasuhiko, Toyoshima Naoya, Nonaka Satoru, Suzuki Haruhisa, Yoshinaga Shigetaka, Kitabayashi Issay, Daiko Hiroyuki, Saito Yutaka, Yahagi Naohisa
Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Surg Endosc. 2025 Jul;39(7):4402-4410. doi: 10.1007/s00464-025-11809-y. Epub 2025 May 30.
Red dichromatic imaging (RDI) is an image-enhanced endoscopy expected to improve the visibility of bleeding source. We aimed to analyze color difference and hemostasis time between white light imaging (WLI) and RDI during endoscopic submucosal dissection (ESD).
This was a single-center post hoc analysis of a multicenter randomized controlled trial (RCT) to verify the efficacy and safety of RDI in hemostasis during ESD. We included patients with intraprocedural bleeding enrolled in an RCT at our institution. We extracted videos of intraoperative bleeding and annotated bleeding source in each frame. We calculated the mean color difference (ΔE) between the bleeding source and eight surrounding areas for each frame. We also evaluated the visibility score of the bleeding source.
Thirty-nine and 63 hemostasis were performed among 30 patients in WLI (n = 16) and RDI (n = 14) groups. The ΔE ± standard error (SE) was significantly higher in RDI than in WLI (14.2 ± 0.5 and 11.7 ± 0.8, p = 0.01). The ΔE ± SE for spurting and oozing hemorrhage was 9.3 ± 0.9 and 13.6 ± 0.7 (p = 0.02) and 12.4 ± 1.0 and 14.5 ± 0.5 (p = 0.47), and mean hemostasis time ± SE (seconds) was 44.5 ± 7.9 and 25.9 ± 3.8 (p = 0.04) in WLI and RDI, respectively. The mean visibility score was significantly higher in RDI than in WLI (3.36 ± 0.7 vs 2.78 ± 1.0, p < 0.01).
RDI demonstrated a higher color difference in the bleeding source than WLI. This could improve the visibility of a bleeding source, particularly spurting hemorrhage.
红色双色成像（RDI）是一种图像增强型内镜检查技术，有望提高出血源的可视性。我们旨在分析内镜黏膜下剥离术（ESD）期间白光成像（WLI）与RDI之间的色差和止血时间。
这是一项对多中心随机对照试验（RCT）的单中心事后分析，以验证RDI在ESD止血中的有效性和安全性。我们纳入了在我们机构参加RCT的术中出血患者。我们提取了术中出血的视频，并对每一帧中的出血源进行注释。我们计算了每一帧中出血源与八个周围区域之间的平均色差（ΔE）。我们还评估了出血源的可视性评分。
WLI组（n = 16）和RDI组（n = 14）的30例患者分别进行了39次和63次止血。RDI组的ΔE±标准误差（SE）显著高于WLI组（分别为14.2±0.5和11.7±0.8，p = 0.01）。喷射性出血和渗血的ΔE±SE分别为9.3±0.9和13.6±0.7（p = 0.02）以及12.4±1.0和14.5±0.5（p = 0.47），WLI组和RDI组的平均止血时间±SE（秒）分别为44.5±7.9和25.9±3.8（p = 0.04）。RDI组的平均可视性评分显著高于WLI组（3.36±0.7对2.78±1.0，p < 0.01）。
RDI显示出血源处的色差高于WLI。这可以提高出血源的可视性，尤其是喷射性出血。
