Efficacy of using red dichromatic imaging throughout endoscopic submucosal dissection procedure

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Medical Imaging Technology

Background:

• Management of bleeding during endoscopic submucosal dissection (ESD) is critical for patient safety.
• Red Dichromatic Imaging (RDI) is an advanced endoscopic technology that improves visualization of deep vessels and bleeding sources compared to standard white light imaging (WLI).
• The hypothesis is that utilizing RDI throughout the entire cutting phase of ESD (FTR-ESD) may lead to improved resection rates, reduced procedure times, and fewer complications.

Purpose of the Study:

• To investigate the efficacy and safety of full time RDI ESD (FTR-ESD) compared to WLI-ESD.
• To evaluate the impact of FTR-ESD on key procedural metrics such as resection rate, procedure time, and complication occurrence.
• To determine if FTR-ESD offers advantages in terms of dissection speed and overall therapeutic outcomes.

Main Methods:

• A retrospective observational study was conducted on 82 patients undergoing ESD for esophageal, gastric, or colorectal cancers.
• Procedures were performed by a single expert endoscopist between January 2018 and March 2021.
• Outcomes were analyzed comparing early cases using WLI-ESD (n=57) with later cases using FTR-ESD (n=25).

Main Results:

• The median procedure time was similar between FTR-ESD (35 min) and WLI-ESD (40 min), not reaching statistical significance (p=0.34).
• FTR-ESD demonstrated a significantly faster median dissection speed (27.23 mm²/min) compared to WLI-ESD (20.94 mm²/min) (p=0.025).
• Multivariate analysis identified tumor size (>30 mm) and FTR-ESD as independent factors for faster dissection speed. No significant differences were observed in R0 resection, en bloc resection, or adverse event rates.

Conclusions:

• FTR-ESD significantly enhances dissection speed compared to WLI-ESD.
• The FTR-ESD procedure can be performed safely, with therapeutic outcomes comparable to WLI-ESD.
• Further multicenter prospective studies are recommended to validate these findings.