Post written by Aoi Kita, MD, and Toshio Uraoka, MD, PhD, from the Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan.

Red Dichromatic Imaging (RDI), a novel image-enhanced endoscopy technology (IEE), has been reported to improve the visibility of deep vessels and bleeding points compared to white-light imaging. We present a case of ESD in the low rectum where RDI was very useful and effective. An 84-year-old man presented with a 18-mm type 0-Is tumor in the low rectum. We decided to perform en bloc resection by ESD for accurate histologic staging. The entire procedure from submucosal injection to mucosal incision and submucosal dissection with complete resection was performed using RDI. Submucosal injection was initiated after assessing location of the deep vessels using RDI. Circumferential mucosal incision was then performed without significant bleeding. When bleeding occurred, we identified bleeding points easily with RDI and achieved targeted, quick, and effective hemostasis.

In this video, we have demonstrated the benefits of full-time RDI that included not only identifying bleeding points for quick and effective hemostasis but also preventing bleeding by avoiding deep vessels. We would like to share our findings that RDI appears to be a promising IEE for reducing risk and facilitating quick treatment of bleeding during endoscopic resections.

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