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Fujii T, Watanabe S, Uga M, Matsui Y, Sakaki K, Matsukawa N, Machida T, Kurihara M, Tashiro Y, Okamoto E, Yauchi T, Suzuki S, Koyama S. Analysis of lens cloudiness during endoscopic submucosal dissection procedures: Effects of a novel lens cleaner. DEN OPEN 2025; 5:e416. [PMID: 39077550 PMCID: PMC11284122 DOI: 10.1002/deo2.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 07/31/2024]
Abstract
Objectives We aimed to identify independent factors for intraoperative endoscopic lens cloudiness during gastric and colorectal endoscopic submucosal dissections, investigate the effectiveness of Cleastay, an endoscope anti-fog solution, and examine factors associated with severe submucosal fat deposition. Methods A total of 220 patients who underwent gastric or colorectal endoscopic submucosal dissections in two institutions between January 2022 and October 2023 were included. Significant factors related to cloudiness were determined using univariate and multivariate analyses. Patient background and tumor characteristics related to severe submucosal fat deposition were investigated, and the degree of intraoperative endoscopic lens cloudiness and outcomes were compared between the Cleash and Cleastay groups. Results In the multivariate analysis, factors increasing lens cloudiness included long procedure time (odds ratio [OR], 17.51; 95% confidence interval [CI], 1.52-202.08), stomach (vs. colon; OR, 5.08; 95% CI, 1.99-12.96), and severe submucosal fat deposition (OR, 12.19; 95% CI, 5.02-29.60). Conversely, the use of Cleastay (vs. Cleash; OR, 0.066; 95% CI, 0.021-0.21) was identified as a factor reducing cloudiness. Location analysis revealed that severe submucosal fat deposition was more common in the upper stomach and right colon. Conclusions It was suggested that Cleastay is more useful for endoscopic submucosal dissection of the upper stomach and right colon, where severe submucosal fat deposition is expected.
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Affiliation(s)
- Takashi Fujii
- Department of GastroenterologyTokyo Metropolitan Hiroo HospitalTokyoJapan
| | - Sho Watanabe
- Department of GastroenterologySoka Municipal HospitalSaitamaJapan
| | - Misugi Uga
- Department of GastroenterologySoka Municipal HospitalSaitamaJapan
| | - Yuuki Matsui
- Department of GastroenterologyTokyo Metropolitan Hiroo HospitalTokyoJapan
| | - Kazuomi Sakaki
- Department of GastroenterologyTokyo Metropolitan Hiroo HospitalTokyoJapan
| | - Naoki Matsukawa
- Department of GastroenterologySoka Municipal HospitalSaitamaJapan
| | - Tomoyo Machida
- Department of GastroenterologySoka Municipal HospitalSaitamaJapan
| | | | - Yoshihiro Tashiro
- Department of GastroenterologyTokyo Metropolitan Hiroo HospitalTokyoJapan
| | - Eiko Okamoto
- Department of GastroenterologyTokyo Metropolitan Hiroo HospitalTokyoJapan
| | - Tsunehito Yauchi
- Department of GastroenterologySoka Municipal HospitalSaitamaJapan
| | - Shinji Suzuki
- Department of GastroenterologyTokyo Metropolitan Hiroo HospitalTokyoJapan
| | - Shigeru Koyama
- Department of EndoscopyTokyo Metropolitan Hiroo HospitalTokyoJapan
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2
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Tanaka H, Oka S, Kunihiro M, Nagata S, Kitamura S, Kuwai T, Hiraga Y, Furudoi A, Tanaka S. Endoscopic submucosal dissection for tumors involving the ileocecal valve with extension into the terminal ileum: a multicenter study from the Hiroshima GI Endoscopy Research Group. Surg Endosc 2023; 37:958-966. [PMID: 36070146 DOI: 10.1007/s00464-022-09542-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 08/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The efficacy and safety of endoscopic submucosal dissection (ESD) for tumors extending into the terminal ileum remain obscure. We aimed to evaluate the outcomes of ESD for tumors involving the ileocecal valve (ICV) with extension into the terminal ileum. METHODS Sixty-eight patients (40 men; mean age, 67 years) with 68 tumors involving the ICV that were resected by ESD between December 2013 and December 2018 were included and classified into Group A (21 tumors with extension into the terminal ileum) and Group B (47 tumors without extension). ESD outcomes were compared between groups. RESULTS The clinical features of the patients and tumors were not significantly different between the groups. There were no significant differences in en bloc resection rate (95% and 94%, respectively; p = 0.79), R0 resection rate (90% and 89%, respectively; p = 0.89), procedure time (95 ± 54 min and 94 ± 69 min, respectively; p = 0.64), postoperative bleeding rate (5% and 3%, respectively; p = 0.79), intraoperative perforation rate (0% and 4%, respectively; p = 0.34), delayed perforation rate (0% and 0%, respectively), or postoperative symptomatic stenosis rate (0% and 0%, respectively) between Groups A and B. No specific factors related to the outcomes of ESD were found by subgroup analysis according to the dominance and degree of circumference of the ICV. Local recurrence was observed in 1 patient in Group A who was retreated using ESD. CONCLUSIONS ESD for tumors involving the ICV with extension into the terminal ileum is safe and effective.
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Affiliation(s)
- Hidenori Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Masaki Kunihiro
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Shosuke Kitamura
- Department of Gastroenterology, JA Onomichi General Hospital, Onomichi, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization Kure Medical Center, Chugoku Cancer Center, Kure, Japan
| | - Yuko Hiraga
- Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Akira Furudoi
- Department of Gastroenterology, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
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3
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Efficacy of using red dichromatic imaging throughout endoscopic submucosal dissection procedure. Surg Endosc 2023; 37:503-509. [PMID: 36001152 DOI: 10.1007/s00464-022-09543-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 08/07/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Management of bleeding during endoscopic submucosal dissection (ESD) is critical. Red Dichromatic Imaging (RDI), a novel image-enhanced endoscopy technology, has been reported to improve the visibility of deep vessels and bleeding source compared to white light imaging (WLI). We hypothesized that using RDI during the entire cutting process (full time RDI ESD: FTR-ESD), higher R0 resection rate, shorter procedure time and fewer complications could be achieved. Therefore, the aims of the present study were to investigate the efficacy and safety of FTR-ESD. METHODS This retrospective observational study included a total of 82 consecutive patients who underwent ESD by a single expert endoscopist for 40 esophageal, 17 gastric and 25 colorectal cancers at our institution from January 2018 to March 2021. The clinicopathological data were collected from patients' medical records and the treatment outcomes were analyzed according to the treatment phase (early; 57 WLI-ESD and late; 25 FTR-ESD). RESULTS The median of the greatest diameter of resected specimen was 40.0 mm. The median procedure time was relatively shorter in the FTR-ESD group (35 min) than in the WLI-ESD group (40 min), but the difference was not statistically significant (p = 0.34). The median dissection speed in the FTR-ESD group (27.23 mm2/min) was significantly faster than that in the WLI-ESD group (20.94 mm2/min) (p = 0.025). The dissection speed was not different among different organs. A multivariate analysis revealed that tumor size (more than 30 mm) and FTR-ESD were significant independent factors contributing to faster dissection speed (p < 0.05). There were no significant differences in the rates of en bloc resection, HM0, VM0 or occurrence of adverse events between WLI-ESD and FTR-ESD. CONCLUSIONS FTR-ESD significantly increases the dissection speed compared to WLI-ESD. FTR-ESD can be performed safely and therapeutic outcomes in FTR-ESD are comparable with WLI-ESD. A further multicenter prospective study is warranted to confirm our results.
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Funasaka K, Miyahara R, Horiguchi N, Omori T, Osaki H, Yoshida D, Yamada H, Koyama K, Nagasaka M, Nakagawa Y, Hashimoto S, Shibata T, Hirooka Y. Novel image enhancement technology that helps find bleeding points during endoscopic submucosal dissection of gastric neoplasms. J Gastroenterol Hepatol 2022; 37:1955-1962. [PMID: 35945162 DOI: 10.1111/jgh.15975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/27/2022] [Accepted: 08/03/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM The management of bleeding during endoscopic submucosal dissection (ESD) is critical and related to the procedure time. We collaborated on a new image enhancement algorithm with parameter optimization for clinical use being developed by FUJIFILM Co. and processed white light image data offline to evaluate the effectiveness of this technology. This study aims to evaluate the clinical usefulness of this technology. METHODS Eighteen video scenes of bleeding points from five gastric ESDs were selected and processed by the new image enhancement algorithm. The time until a bleeding point was found, visibility of a bleeding point, and color abnormality of the submucosal layer were evaluated by ESD experts, ESD trainees, and endoscopy trainees. The color differences between the bleeding point and the surroundings in CIE-L*a*b* color space were calculated in the original and enhanced images. RESULTS The time until a bleeding point was found in the enhanced videos was significantly shorter than that in the original videos (11.10 s vs 13.85 s) (P = 0.017). On a 5-point (-2 to +2) Likert scale of visibility, the enhanced image was slightly superior to the original (+0.45), and the appearance of the submucosa was comparable between images (+0.14). The color difference among the bleeding areas on the enhanced images was significantly larger than that on the original images (10.93 vs 8.36). CONCLUSION This novel image enhancement algorithm emphasizes the color difference between a bleeding point and the surrounding area, which would help find bleeding points faster during ESD for the less experienced endoscopists.
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Affiliation(s)
- Kohei Funasaka
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Noriyuki Horiguchi
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Takafumi Omori
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Hayato Osaki
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Dai Yoshida
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Hyuga Yamada
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Keishi Koyama
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Mitsuo Nagasaka
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoshiyuki Nakagawa
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Senju Hashimoto
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Tomoyuki Shibata
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoshiki Hirooka
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
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Uraoka T, Igarashi M. Development and clinical usefulness of a unique red dichromatic imaging technology in gastrointestinal endoscopy: A narrative review. Therap Adv Gastroenterol 2022; 15:17562848221118302. [PMID: 36082177 PMCID: PMC9445450 DOI: 10.1177/17562848221118302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
Image-enhanced endoscopy (IEE) allows real-time high-contrast imaging of a targeted lesion without any special equipment. Among various IEE technologies, narrow-band imaging, in which a light of shorter wavelength is used, emphasizes the surface and blood vessel patterns on the mucosal surface. This technology has been widely used in endoscopic diagnosis in the gastrointestinal tract. Red dichromatic imaging (RDI) was recently developed; it utilizes lights of longer wavelengths (520-550, 595-610, and 620-640 nm), which have weak light scattering characteristics in contrast to narrow-band imaging. RDI was designed to enhance the visibility of deep-lying blood vessels and areas of bleeding, and it has been installed in the latest Olympus endoscopy system, EVIS X1, as an advanced version of the optical-digital method that was originally developed. Improving the visibility of deep blood vessels allows more accurate evaluation of esophageal varices and the degree of inflammation in ulcerative colitis. Easier identification of a bleeding source makes hemostasis quicker and easier to accomplish during endoscopic resection procedures such as endoscopic submucosal dissection and peroral endoscopic myotomy as well as during treatment of gastrointestinal bleeding from a peptide ulcer or colon diverticulum. The authors herein review the technological development and principles, review the existing literature on RDI, and discuss the utility and effectiveness of this unique IEE technology in gastrointestinal endoscopy.
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Kamigaichi Y, Oka S, Tanaka S, Nagata S, Kunihiro M, Kuwai T, Hiraga Y, Furudoi A, Onogawa S, Okanobu H, Mizumoto T, Miwata T, Okamoto S, Yoshimura K, Chayama K. Factors for conversion risk of colorectal endoscopic submucosal dissection: a multicenter study. Surg Endosc 2022; 36:5698-5709. [PMID: 35579699 DOI: 10.1007/s00464-022-09250-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 04/07/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has become a widely accepted treatment method for colorectal tumors; however, there are some persistent problems. This multi-center study aimed to characterize the risk factors for incomplete resection and perforation in standardized colorectal ESD procedures. METHODS This study included 2423 consecutive patients who underwent ESD for 2592 colorectal tumors between August 2013 and December 2018 at 11 institutions (1 academic hospital and 10 affiliated hospitals) from the Hiroshima GI Endoscopy Research Group. We evaluated the risk factors for interruption, piecemeal resection, and perforation of standardized colorectal ESD in relation to clinicopathologic and endoscopic characteristics. RESULTS The incidences of interruption, piecemeal resection, and perforation were 0.7%, 2.9%, and 3.0%, respectively. Multivariate analysis identified the following risk factors for interruption: perforation during the procedure, deep submucosal invasion (> 1000 μm), poor scope operability, and severe submucosal fibrosis. The risk factors for piecemeal resection included poor scope operability, severe submucosal fibrosis, and procedure time (≥ 85 min). The risk factors for perforation during the procedure were severe submucosal fibrosis, poor scope operability, procedure time (≥ 85 min), and tumor size (≥ 40 mm). Independent risk factors for severe submucosal fibrosis included a history of biopsy and lesions located on the fold or flexure. CONCLUSIONS Severe submucosal fibrosis and poor scope operability are the common risk factors for interruption, piecemeal resection, and perforation in standardized colorectal ESD.
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Affiliation(s)
- Yuki Kamigaichi
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Minami-ku, Kasumi, Hiroshima, 734-8551, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Minami-ku, Kasumi, Hiroshima, 734-8551, Japan.
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Masaki Kunihiro
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Yuko Hiraga
- Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Akira Furudoi
- Department of Gastroenterology, Hiroshima General Hospital, Hiroshima, JA, Japan
| | - Seiji Onogawa
- Department of Gastroenterology, Onomichi General Hospital, Hiroshima, Japan
| | - Hideharu Okanobu
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Takeshi Mizumoto
- Department of Gastroenterology, Miyoshi Central Hospital, Hiroshima, Japan
| | - Tomohiro Miwata
- Department of Gastroenterology, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Shiro Okamoto
- Department of Gastroenterology, Kure Kyosai Hospital, Hiroshima, Japan
| | - Kenichi Yoshimura
- Division of Regeneration and Medicine Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Minami-ku, Kasumi, Hiroshima, 734-8551, Japan
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Tanaka H, Oka S, Tsuboi A, Kamigaichi Y, Tamari H, Sumioka A, Shimohara Y, Nishimura T, Inagaki K, Okamoto Y, Iio S, Yamashita K, Sumimoto K, Tanaka S. Efficacy of single-balloon overtube for endoscopic submucosal dissection in the proximal colon: A propensity score-matched analysis. DEN OPEN 2022; 2:e58. [PMID: 35310737 PMCID: PMC8828212 DOI: 10.1002/deo2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/18/2021] [Accepted: 08/27/2021] [Indexed: 04/14/2023]
Abstract
OBJECTIVES A single-balloon overtube (SBO) can improve poor scope operability during colonic endoscopic submucosal dissection (ESD). We aimed to evaluate the clinical usefulness of SBO for ESD in the proximal colon and the predictive factors for cases in which SBO is useful. METHODS A total of 88 tumors located in the proximal colon resected by balloon-assisted ESD (BA-ESD) using SBO and 461 tumors resected by conventional ESD (C-ESD) between June 2015 and November 2020 were considered. Seventy-eight tumors each in the BA-ESD and C-ESD groups were matched by propensity score matching. ESD outcomes were compared between the groups, and a decision tree analysis was performed to explore the predictive factors for cases in which SBO is useful. RESULTS There were no significant differences between the groups in the major outcomes such as en bloc resection rate (95% vs. 99%, p = 0.17), R0 resection rate (92% vs. 96%, p = 0.30), mean dissection speed (16 mm2/min vs. 16 mm2/min, p = 0.53), and intraoperative perforation rate (5% vs. 6%, p = 0.73). Even when considering cases with poor preoperative scope operability, there were no significant differences between the groups. Comparison of tumors ≥40 mm in diameter between the groups confirmed that the intraoperative perforation rate was significantly lower in the BA-ESD group than in the C-ESD group (0% vs. 24%, p = 0.0188). CONCLUSION SBO is useful for ESD of tumors ≥40 mm in diameter in the proximal colon to prevent intraoperative perforation, which usually has a long procedure time.
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Affiliation(s)
- Hidenori Tanaka
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
| | - Shiro Oka
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Akiyoshi Tsuboi
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
| | - Yuki Kamigaichi
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Hirosato Tamari
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Akihiko Sumioka
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Yasutsugu Shimohara
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Tomoyuki Nishimura
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Katsuaki Inagaki
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Yuki Okamoto
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Sumio Iio
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Ken Yamashita
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
| | - Kyoku Sumimoto
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
| | - Shinji Tanaka
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
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8
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Furuichi Y, Abe M, Takeuchi H, Yoshimasu Y, Itoi T. Red dichromatic imaging reduces endoscopic treatment time of esophageal varices by increasing bleeding point visibility (with video). Dig Endosc 2022; 34:87-95. [PMID: 33971049 DOI: 10.1111/den.14011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Red dichromatic imaging (RDI) is a novel image-enhanced endoscopy released in 2020, which increases the visibility of deeper vessels. In this study, we retrospectively investigated whether RDI can shorten treatment times of endoscopic injection sclerotherapy (EIS), and which operational procedure times are affected compared with white light imaging (WLI). METHODS A total of 155 patients (RDI, 70; WLI, 85) with risky esophageal varices (EV), who were treated with EIS were analyzed. Treatment times were compared, and predictors associated with treatment time were analyzed by multivariate analysis. For 24 cases (RDI, 12; WLI, 12) in which treatment videos were recorded, the procedure times of each step (observation of EV, needle flush, positioning, puncture, observation of bleeding, hemostasis, observation after hemostasis) were measured. Regarding the seven patients with EV bleeding, color differences were calculated between the bleeding point and the blood pool using the CIE (L*a*b*) color measurement method, and results were compared between using RDI and WLI. RESULTS Treatment times were shorter in the RDI group (RDI vs. WLI = 35.1 vs. 42.2 min; P < 0.01). 'RDI function' and 'amount of sclerosant' were extracted as independent predictors of treatment time. Times for 'observation of EV' and 'observation of bleeding' were shorter in the RDI group (P = 0.01 and <0.01, respectively). Regarding the color difference, RDI significantly increased bleeding point visibility (RDI vs. WLI = 31.4 ± 11.8 vs. 8.6 ± 6.2, P < 0.001). CONCLUSION Red dichromatic imaging can shorten the treatment time of EIS by increasing bleeding point visibility.
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Affiliation(s)
- Yoshihiro Furuichi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.,Department of Gastroenterology, Niiza Shiki Central General Hospital, Saitama, Japan
| | - Masakazu Abe
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hirohito Takeuchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yuu Yoshimasu
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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9
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Nabi Z, Chavan R, Ramchandani M, Darisetty S, Reddy DN. Endoscopic submucosal dissection and tunneling procedures using novel image-enhanced technique. VideoGIE 2022; 7:158-163. [PMID: 35937197 PMCID: PMC9347009 DOI: 10.1016/j.vgie.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background and Aims Recent innovations in image-enhanced endoscopy allow early detection and management of GI lesions. In this study, we aim to analyze the utility of texture and color enhancement imaging (TXI) and red dichromatic imaging (RDI) during endoscopic submucosal dissection (ESD) and submucosal tunneling procedures. Methods Patients who underwent ESD, submucosal tunneling endoscopic resection, and peroral endoscopic myotomy (POEM) using the novel imaging technique including TXI and RDI were included in the study. Results Twenty-five patients (13 male; age 43 ± 15.69 years) underwent POEM for achalasia (n = 20), submucosal tunneling endoscopic resection for esophageal subepithelial lesions (n = 3), and ESD for gastric neuroendocrine tumors (n = 2). All of the procedures were successfully performed. Mean procedure duration was 55.52 ± 21.61 minutes. TXI mode was used in all the cases, whereas RDI mode was used on 15 occasions. While using RDI mode, hemostasis was achieved in 1 attempt on 12 (80%) occasions. The site of mucosal incision was revised in 3 cases during POEM based on TXI and RDI modes. Conclusions Submucosal tunneling and endoscopic dissection procedures can be conveniently performed using a new image-enhanced technique. RDI is useful in localizing the site of bleeding during endoscopic dissection.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Radhika Chavan
- Asian Institute of Gastroenterology, Hyderabad, Telangana, India
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10
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Miyamoto S, Sugiura R, Abiko S, Hatanaka K, Yamamoto Y, Naruse H, Sakamoto N. Red dichromatic imaging helps in detecting exposed blood vessels in gastric ulcer induced by endoscopic submucosal dissection. Endoscopy 2021; 53:E403-E404. [PMID: 33336336 DOI: 10.1055/a-1314-9714] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Shuichi Miyamoto
- Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate, Japan.,Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Ryo Sugiura
- Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Satoshi Abiko
- Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Kazuteru Hatanaka
- Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Yoshiya Yamamoto
- Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Hirohito Naruse
- Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
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11
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Miyamoto S, Ohya TR, Nishi K, Abiko S, Sugiura R, Yamamoto Y, Sakamoto N. Effectiveness of red dichromatic imaging for dissection of the submucosal layer when hematoma is encountered. Endoscopy 2021; 53:E413-E414. [PMID: 33445202 DOI: 10.1055/a-1333-0831] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Shuichi Miyamoto
- Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate, Japan.,Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Tomohiko R Ohya
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Kaori Nishi
- Department of Nursing, Hakodate Municipal Hospital, Hakodate, Japan
| | - Satoshi Abiko
- Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Ryo Sugiura
- Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Yoshiya Yamamoto
- Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
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Ramos-Zabala F, Parra-Blanco A, Beg S, Rodríguez-Pascual J, Cárdenas Rebollo JM, Cardozo-Rocabado R, Moreno-Almazán L. The impact of submucosal fatty tissue during colon endoscopic submucosal dissection in a western center. Eur J Gastroenterol Hepatol 2021; 33:1063-1070. [PMID: 33867446 DOI: 10.1097/meg.0000000000002146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Obesity is associated with submucosal fatty tissue. The main aim of this study was to assess the impact of submucosal fatty tissue on the success of colonic endoscopic submucosal dissection (C-ESD) in a western population. METHODS This was a retrospective analysis of 125 consecutive C-ESDs performed between October 2015 and July 2017. Fatty tissue sign was defined as positive when the submucosal layer was covered with fatty tissue. The complexity of performing an ESD was assessed by the performing endoscopist, defined by the occurrence of intraprocedural perforation, inability to complete an en-bloc resection or a procedure time exceeding 180 min. RESULTS Fatty tissue sign positive was present in 44.8% of the procedures. There were 28 (22.4%) c-ESD defined as complex. Factors associated with complex ESD included; fatty tissue sign [odds ratio (OR) 12.5; 95% confidence interval (CI), 1.9-81.9; P = 0.008], severe fibrosis (OR 148.6; 95% CI, 6.6-3358.0; P = 0.002), poor maneuverability (OR 267.4; 95% CI, 11.5-6212.5; P < 0.001) and polyp size ≥35 mm (OR 17.2; 95% CI, 2.6-113.8; P = 0.003). In patients demonstrating the fatty tissue sign, BMI and waist-to-height ratio (WHtR) were higher (27.8 vs. 24.7; P < 0.001 and 0.56 vs. 0.49; P < 0.001, respectively) and en-bloc resection was achieved less frequently (76.8 vs. 97.1%, P = 0.001). Multivariate analysis revealed higher risk of fatty tissue sign positive associated with WHtR ≥0.52 (OR 26.10, 95% CI, 7.63-89.35, P < 0.001). CONCLUSION This study demonstrates that the fatty tissue sign contributes to procedural complexity during C-ESD. Central obesity correlates with the likelihood of submucosal fatty tissue and as such should be taken into account when planning procedures.
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Affiliation(s)
- Felipe Ramos-Zabala
- Departamento de Gastroenterología, Hospital Universitario HM Montepríncipe, HM Hospitales, Boadilla del Monte
- Departamento de Ciencias Médicas Clínicas, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, España
| | - Adolfo Parra-Blanco
- Department of Gastroenterology, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Sabina Beg
- Department of Gastroenterology, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Jesús Rodríguez-Pascual
- Departamento de Ciencias Médicas Clínicas, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, España
- Departamento de Oncología Médica
| | - José Miguel Cárdenas Rebollo
- Departamento de Ciencias Médicas Clínicas, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, España
| | - Rocío Cardozo-Rocabado
- Departamento de Anatomía Patológica, Hospital Universitario HM Puerta del Sur, HM Hospitales, Moóstoles, Madrid, España
| | - Luis Moreno-Almazán
- Departamento de Gastroenterología, Hospital Universitario HM Montepríncipe, HM Hospitales, Boadilla del Monte
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13
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Impact of obesity in colorectal endoscopic submucosal dissection: single-center retrospective cohort study. BMC Gastroenterol 2021; 21:74. [PMID: 33593282 PMCID: PMC7885483 DOI: 10.1186/s12876-021-01652-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/02/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND When performing colorectal endoscopic submucosal dissection (ESD) in obese patients, technically difficult cases are sometimes experienced because of difficulty with the insertion of the colonoscope, poor scope maneuverability, or an abundance of fat tissue in the submucosal layer. Since the association between obesity and colorectal ESD has not been investigated, we evaluated the clinical impact of obesity in patients who underwent colorectal ESD. METHODS We retrospectively reviewed 535 patients who underwent colorectal ESD between April 2012 and February 2019. Patients were divided into three groups based on their body mass index (BMI): a control group (BMI < 25 kg/m2), an overweight group (25 kg/m2 ≤ BMI < 30 kg/m2), and an obese group (BMI ≥ 30 kg/m2), and the short-term clinical outcomes were analyzed to assess the safety and difficulty of colorectal ESD. RESULTS No significant difference in the procedure times, en bloc resection rates, pathological diagnoses, or complications were seen among the groups. While the amount of sedative per body weight was significantly lower in the group with a higher BMI (flunitrazepam: 1.75 × 10-2 [1.27 × 10-2-2.34 × 10-2] mg/kg vs. 1.48 × 10-2 [1.08 × 10-2-2.03 × 10-2] mg/kg vs. 1.16 × 10-2 [0.98 × 10-2-1.54 × 10-2] mg/kg, P < 0.001; pethidine: 0.63 [0.55-0.72] mg/kg vs. 0.50 [0.46-0.56] mg/kg vs. 0.39 [0.32-0.45] mg/kg, P < 0.001), a reduction in percutaneous arterial oxygen saturation occurred significantly more frequently in the group with a higher BMI (123 [30.2%] vs. 43 [43.9%] vs. 10 [55.6%], P = 0.005). When the procedures were performed by trainees, the number of cases that required a procedure time of longer than 90 min was significantly larger in the group with a higher BMI (27 [10.8%] vs. 14 [21.9%] vs. 3 [25.0%], P = 0.033). CONCLUSIONS This study showed that colorectal ESD could be performed safely and effectively in obese patients. However, ESD in obese patients requires attention, particularly to changes in respiratory conditions.
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He Z, Wang P, Liang Y, Fu Z, Ye X. Clinically Available Optical Imaging Technologies in Endoscopic Lesion Detection: Current Status and Future Perspective. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:7594513. [PMID: 33628407 PMCID: PMC7886528 DOI: 10.1155/2021/7594513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 01/02/2023]
Abstract
Endoscopic optical imaging technologies for the detection and evaluation of dysplasia and early cancer have made great strides in recent decades. With the capacity of in vivo early detection of subtle lesions, they allow modern endoscopists to provide accurate and effective optical diagnosis in real time. This review mainly analyzes the current status of clinically available endoscopic optical imaging techniques, with emphasis on the latest updates of existing techniques. We summarize current coverage of these technologies in major hospital departments such as gastroenterology, urology, gynecology, otolaryngology, pneumology, and laparoscopic surgery. In order to promote a broader understanding, we further cover the underlying principles of these technologies and analyze their performance. Moreover, we provide a brief overview of future perspectives in related technologies, such as computer-assisted diagnosis (CAD) algorithms dealing with exploring endoscopic video data. We believe all these efforts will benefit the healthcare of the community, help endoscopists improve the accuracy of diagnosis, and relieve patients' suffering.
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Affiliation(s)
- Zhongyu He
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Peng Wang
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Yuelong Liang
- Department of General Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Zuoming Fu
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Xuesong Ye
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
- State Key Laboratory of CAD and CG, Zhejiang University, Hangzhou 310058, China
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15
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Yorita N, Oka S, Tanaka S, Kotachi T, Nagasaki N, Hata K, Kuroki K, Masuda K, Kurihara M, Kiso M, Boda T, Ito M, Chayama K. Clinical Usefulness of Dual Red Imaging in Gastric Endoscopic Submucosal Dissection: A Pilot Study. Clin Endosc 2019; 53:54-59. [PMID: 31476844 PMCID: PMC7003015 DOI: 10.5946/ce.2019.065] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/09/2019] [Indexed: 12/17/2022] Open
Abstract
Background/Aims Dual red imaging (DRI) is a new, image-enhanced endoscopy technique. There are few reports about the usefulness of DRI during gastric endoscopic submucosal dissection (ESD). We aimed to examine the usefulness of DRI in endoscopic hemostasis during gastric ESD.
Methods We enrolled a total of 20 consecutive patients who underwent gastric ESD. Five endoscopists compared DRI with white light imaging (WLI) for the visibility of blood vessels and bleeding points while performing endoscopic hemostasis.
Results The visibility of blood vessels was increased in 56% (19/34) of the cases, and the visibility of bleeding points was improved in 55% (11/20) of the cases with the use of DRI compared with the use of WLI.
Conclusions DRI improved the visibility of blood vessels and bleeding points in cases with oozing bleeding, blood pooling around the bleeding points, and multiple bleeding points.
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Affiliation(s)
- Naoki Yorita
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Takahiro Kotachi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Naoko Nagasaki
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kosaku Hata
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazutaka Kuroki
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuhiko Masuda
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Mio Kurihara
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Mariko Kiso
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomoyuki Boda
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Masanori Ito
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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