Introduction:
Intra-procedural hemostasis has been a crucial step during advance endoscopic procedures like Endoscopic Submucosal Dissection and other third space procedures. Bleeding tends to distort the operative field and it can be a nightmare for endoscopist.
Objective:
To evaluate the effectiveness of recent developments in Endoscopic imaging in terms of RDI (Red Dichromatic Imaging) for enhancing the visibility of deep seated blood vessels and bleeding sources during ESD procedure.
History:
A 55 year old male came for screening colonoscopy with a strong family history of CRC. His routine blood reports were within normal limits. USG whole Abdomen- Normal.
Equipment Used:
EVIS X1 CV-1500, RDI with CF-EZ 1500 colonoscope on OEV321UH-4K LCD monitor.
Conclusion:
Colonoscopy revealed a large NICE II PARIS Isp lesion which was characterized using TXI mode I and appeared to be adenomatous in terms of surface villi pattern, vessels pattern and color background. ESD was planned and dissection started following conventional steps. Submucosal dissection was carried out with hemostasis of intervening vessels. During the dissection, we encounter a feeding vessel which was large and started bleeding obscuring the field of vision and it was difficult to target a bleeding point due to “red out”. At this point of time, RDI mode was switched on which enabled us to localize a bleeding point. The vessel was targeted and coagulated with coag grasper in no time. RDI mode is highly effective in enhancing visibility of bleeding source. It saves time at a crucial point during the procedure.
Images:
Fig. I NICE II lesion on NBI
Fig. II Surface and Texture characterization TXI mode I
Fig. III Intra-procedural bleeding obscuring field
Fig IV RDI mode enhancing the bleeding point
Fig. V Targeted coagulation with coag grasper
Dr. Chintan Patel
Dept. of Interventional GI Endoscopy,
SIDS Hospital and Research center,
Surat, Gujarat, India.
