Red dichromatic imaging reduces bleeding and hematoma during submucosal injection in esophageal endoscopic submucosal dissection
Red dichromatic imaging reduces bleeding and hematoma during submucosal injection in esophageal endoscopic submucosal dissection
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DOI：
10.1007/s00464-022-09244-4
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发表时间：
2022-04-18
影响因子：
3.1
通讯作者：
Yahagi, Naohisa
中科院分区：
文献类型：
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作者：
Miyazaki, Kurato;Kato, Motohiko;Yahagi, Naohisa
背景在食管内镜粘膜下剥离术（ESD）中，粘膜下注射期间出血和血肿形成降低了粘膜下的可见性。红色二色性成像（RDI）是一种内窥镜技术，可更好地显示深层粘膜下血管。我们推测RDI可以避免血管损伤。该初步研究评价了RDI在预防食管ESD期间出血和血肿形成方面的作用。方法本研究为单中心回顾性观察研究。我们对60例接受ESD的患者进行了白色光成像（WLI）和RDI检查。由一名内窥镜医生审查所有手术视频，以记录出血事件的发生率和严重程度。18个视频提供了足够的质量和细节，在WLI和RDI下评价了这些视频中穿过病变粘膜切口线的血管数量。结果与RDI组相比，WLI组的单位面积血肿发生率显著更高（0.18/cm（2）[范围0-0.38] vs. 0 [0-0.18]/cm（2），p = 0.024）。WLI组总出血事件的发生率也显著高于RDI组（42.9% [范围21.7-60.4] vs 16.7% [范围13.8-22.9]，p < 0.001）。与WLI相比，RDI下可见的血管显著更多（5 [范围4-8] vs. 2 [范围1-5]，p = 0.0020）。结论RDI可减少食管ESD黏膜下注射时出血和血肿的发生。据推测，RDI对血管可见性的改善可能促成了该结果。
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/cm(2) [range 0-0.38] vs. 0 [0-0.18]/cm(2), 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.