Intraoperative bleeding is a major complication of endoscopic submucosal dissection
(ESD). Various devices and techniques have been developed to control intraoperative
bleeding [1]
[2]
[3]
[4]. Amber red color imaging is a recently developed observation modality that integrates
brightness and color-enhancement technology used in linked color imaging, characterized
by an increased proportion of long-wavelength relative linked color imaging, which
targets the mucosa [5]. These amber red color imaging features improve the visibility of blood vessels
and active bleeding points in the deep submucosa. Herein, we present a case of a colonic
laterally spreading tumor that was treated with ESD using amber red color imaging
([Video 1]).
Enhanced visualization of vessels in submucosa by amber red color imaging in colonic
endoscopic submucosal dissection.Video 1
A 25-mm laterally-spreading tumor was detected in the sigmoid colon. ESD was performed
using an electrosurgical knife (Flush Knife BT 1.5; Fujifilm, Tokyo, Japan) and EC-760ZP-V/M
colonoscope (Fujifilm) paired with an ELUXEO 7000 video system (Fujifilm). Mucosal
injection and circumferential incision followed by submucosal dissection were performed
from the anal side to the oral side. With the blue color of the submucosa preserved,
the overall visibility of the submucosa obtained with amber red color imaging was
equivalent to that obtained with white light imaging (WLI). The visibility of vessels
in the deep submucosa is greatly enhanced by amber red color imaging, which facilitates
the easy and safe precoagulation of thick vessels and reduces the risk of intraoperative
bleeding ([Fig. 1]). Even when intraoperative bleeding occurred in the submucosa, amber red color imaging
visualized active bleeding points as deep yellow against a background of surrounding
yellow, indicating accumulated blood, whereas these points were not clearly visible
with WLI ([Fig. 2]). Using amber red color imaging, quick and effective hemostasis was achieved in
this case and en bloc resection was achieved without complications.
Fig. 1 Endoscopic images during mucosal incision obtained with white light imaging and amber
red color imaging. a White light imaging. b Amber red color imaging.
Fig. 2 Endoscopic images of active bleeding during submucosal dissection obtained with white
light imaging and amber red color imaging. Arrow indicates the active bleeding point.
a White light imaging. b Amber red color imaging.
In conclusion, amber red color imaging in ESD could be useful for reducing the risk
of intraoperative bleeding by identifying thick vessels and active bleeding points,
facilitating quick and safe hemostasis. Amber red color imaging makes ESD easier and
safer.
Endoscopy_UCTN_Code_TTT_1AQ_2AD_3AD
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
process. We grant 100% waivers to articles whose corresponding authors are based in
Group A countries and 50% waivers to those who are based in Group B countries as classified
by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
