Successful hemostasis with red dichromatic imaging for bleeding rectal dieulafoy’s lesion

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]).

Fig. 1 Active bleeding was found from the rectal Dieulafoy’s lesion.

There is active bleeding found in the rectum. Under red dichromatic imaging mode, hemostasis was facilitated by the easy separation of the active bleeder and the surrounding blood pool.Video 1

Fig. 2 The bleeding point was accurately located after switching to red dichromatic imaging mode.

Fig. 3 Endoscopic view of successful hemostasis.

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.

Endoscopy_UCTN_Code_CCL_1AD_2AF

Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Oka K, Iwai N, Okuda T. et al. Red dichromatic imaging improves visibility of bleeding during gastric endoscopic submucosal dissection. Sci Rep 2023; 13: 8560
• 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 DOI: 10.1159/000504386. (PMID: 31865356)
• 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 DOI: 10.1097/SLE.0b013e318172ab1b. (PMID: 18716542)

Publication History

Article published online:
15 February 2024