Visualization and endoscopic treatment of ruptured anastomotic varices using red dichromatic imaging: a case report

Red Dichromatic Imaging (RDI) is an advanced endoscopic technology designed to enhance the visualization of gastrointestinal bleeding. While RDI with Mode 2 has demonstrated significant efficacy in the detection and management of esophageal varices, its role in treating anastomotic varices remains underexplored. We report a challenging case of anastomotic variceal rupture, highlighting the advantages of RDI in precise localization and treatment. A woman in her 70 s with a history of pancreaticoduodenectomy for pancreatic head cancer and liver metastasis, presented with melena, fever, and suspected cholangitis during chemotherapy. Laboratory findings revealed anemia, leukocytosis, and elevated biliary enzymes. Blood transfusion and antibiotic therapy were initiated. CT revealed portal vein stenosis and contrast extravasation into the jejunum. Endoscopy showed a white plug at the gastrojejunal anastomosis, but no visible varices on white light imaging. RDI with Mode 2 identified subtle color changes, enabling successful N-butyl-2-cyanoacrylate injection. Accumulation of lipiodol confirmed variceal obliteration. No further bleeding occurred, and the patient was discharged in stable condition on hospital day 19. This case suggests that RDI may improve the detection and therapeutic precision of ectopic varices and serve as a valuable adjunct in their management.