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DOI: 10.1055/a-2253-8797
Successful hemostasis with red dichromatic imaging for bleeding rectal dieulafoy’s lesion
Supported by: Changhua Christian Hospital (111-CCH-IRP-011 and 112-CCH-IRP-033)
A 74-year-old man with a history of type 2 diabetes mellitus and hemodialysis suffered from bloody stool for 2 days and underwent a colonoscopy. Laboratory data showed a drop in hemoglobin to 7.2 g/dL. During the colonoscopy, fresh blood was observed in the rectum, where a Dieulafoy's lesion was actively bleeding. Under the white light image, the intestinal wall was coated with fresh blood, making it difficult to clearly identify the bleeding point ([Fig. 1], [Video 1]). We switched to the red dichromatic imaging (RDI) mode for further examination, which allowed us to accurately locate the bleeding point and perform hemostasis ([Fig. 2]). In the end, the hemostasis of Dieulafoyʼs lesion was successfully achieved ([Fig. 3]).
RDI is part of a new-generation image-enhanced endoscopy system (EVIS X1; Olympus Marketing, Tokyo, Japan). It utilizes both red and amber wavelengths (600 nm and 630 nm) to enhance the color contrast between the bleeder and surrounding blood pool and facilitate the identification of bleeding sites [1]. Previous reports have demonstrated its usefulness to facilitate endoscopic submucosal dissection procedures. Furthermore, the actual bleeder of a peptic ulcer [2] or post-sphincterectomy [3] was identified rapidly and precisely in RDI mode.
Dieulafoy’s lesion is an uncommon cause of acute gastrointestinal bleeding [4]. In this case, RDI could effectively assist in hemostasis, especially for inexperienced endoscopists in the emergency setting.
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Publication History
Article published online:
15 February 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
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- 2 Kubosawa Y, Mori H, Fujimoto A. Utility of dual red imaging for endoscopic hemostasis of gastric ulcer bleeding. Dig Dis 2020; 38: 352-354
- 3 Toyonaga H, Hayashi T, Nakamura R. et al. Effective application of self-assembling peptide matrix with the gel immersion technique and red dichromatic imaging for hemostasis of postendoscopic sphincterotomy bleeding. Endoscopy 2023; 55: E72-E73
- 4 Chen YY, Yen HH. Massive bleeding from a rectal dieulafoy lesion: combined multidetector-row CT diagnosis and endoscopic therapy. Surg Laparosc Endosc Percutan Tech 2008; 18: 398-399