Red dichromatic imaging enhances submucosal visibility during endoscopic submucosal dissection: Pilot study

Area of Science:

• Gastroenterology
• Endoscopic Imaging
• Surgical Technology

Background:

• Red dichromatic imaging (RDI) is a novel image-enhanced endoscopy (IEE) technology introduced in 2020.
• Clinical evidence for RDI's applications, particularly in endoscopic submucosal dissection (ESD), is limited.
• Clear visualization of the dissecting layer is crucial but challenging during ESD for gastrointestinal tumors.

Purpose of the Study:

• To evaluate the efficacy of RDI in improving visualization of the dissecting layer during ESD.
• To compare RDI with conventional white light imaging (WLI) for dissecting layer visibility.
• To analyze the color differences between tissue layers using RDI and WLI.

Main Methods:

• Eight endoscopists evaluated 86 images from 43 gastrointestinal tumors (esophagus, stomach, duodenum, colon, rectum).
• Dissecting layer visibility was rated on a scale from -2 (poor) to 2 (excellent) under WLI and RDI.
• Color differences between submucosal and muscular layers were analyzed using the CIELab color space system.

Main Results:

• RDI significantly enhanced the visibility of the dissecting layer compared to WLI.
• RDI demonstrated a significantly greater color difference between the submucosal and muscular layers than WLI.
• Objective color analysis supported the subjective visibility assessments.

Conclusions:

• RDI improves visualization during ESD by enhancing dissecting layer visibility and color differentiation.
• The integration of RDI into routine endoscopic practice may enable more precise and efficient ESD procedures.
• Enhanced visualization through RDI has the potential to improve patient outcomes in gastrointestinal tumor treatment.