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Colorectal Case 1

Prof. Naohisa Yahagi

Cancer Center, Keio University Hospital, Japan

*Prof. Naohisa Yahagi, MD, the authoring physician of this presentation, is a paid consultant to Olympus Corporation of the Americas.

Procedure Information

Scope: PCF-H190I

Case Findings: Rectal ESD

Organ:Rectum

Patient information: M, 77

Medical history: N/A

RDI™ technology is not intended to replace histopathological sampling as a means of diagnosis.

1. WLI Observation

At the beginning of ESD, observe the lesion to be removed and the area to be injected under WLI.

2. RDI Mode 2 observation

During injection it is possible to injure blood vessel and cause bleeding. Therefore, switch from WLI to RDI Mode 2 and confirm if there is a thick, deep blood vessel. Visibility of the thick, deep blood vessel is improved with RDI Mode 2 compared to the WLI image. 1)

3. Injection under RDI Mode 2

Under RDI Mode 2, insert the needle making sure to avoid deep blood vessel and inject.

4. Injection under RDI Mode 2

Successful injection without causing any bleeding.

Case Video

5. Dissection

During dissection stage of ESD it is possible to cause bleeding.

6. Bleeding

Assessment of the bleeding point is needed for hemostasis.

7. RDI Mode 1

RDI Mode 1 enhances the visibility of bleeding points by highlighting them in a darker amber color which indicates area of high hemoglobin concentration. This improved visibility allows for quick and easy hemostasis. Additionally, RDI mode 1 helps us to assess the degree of bleeding and to choose the appropriate method of hemostasis. 1) 2)

8. Hemostasis

This time, it is the case of mild bleeding, I can perform contact coagulation with a retracted knife tip (DualKnife J™ Electrosurgical Knife) instead of conventional hemostasis with hemostatic forceps (Coagrasper™ Hemostatic Forceps).

9. Completion

Using RDI mode 1 to confirm hemostasis, and move onto next dissection.

Case Video

Overall Comment

Although no studies are yet to verify the effectiveness of RDI technology, in my experience the use of RDI technology may help reduce hemostasis and treatment times. I have experienced the application of RDI technology to support hemostasis of gastrointestinal bleeding and diagnosis or treatment of esophageal varices in my medical center. Additionally, I have been experiencing the benefits of RDI technology use in cases outside of ESD.

I feel strong psychological stress when the entire monitor view turns red due to bleeding. I believe that visualizing hemorrhages in amber color instead of red decreases the sense of urgency and stress of operators towards bleeding, which allows operators to identify the bleeding point easily and perform hemostasis in a composed manner.

I expect that the efficiency and quality of endoscopic diagnosis and treatment are supported using the multiple functions of the EVIS X1™ endoscopy system, including RDI technology.

Disclaimer

The EVIS X1™ Endoscopy System is not designed for cardiac applications. Other combinations of equipment may cause ventricular fibrillation or seriously affect the cardiac function of the patient. Improper use of endoscopes may result in patient injury, infection, bleeding, and/or perforation. Complete indications, contraindications, warnings, and cautions are available in the Instructions for Use (IFU).

This site is published by Olympus America Inc., which is solely responsible for its contents and is intended for U.S. audiences only. Not all products are available for sale in all markets.

This site is intended for Healthcare Professionals. If you are a patient, it is important that you discuss information about the benefits and risks of products with your doctor.

RDI technology is not intended to replace histopathology sampling as a means of diagnosis.

1) Data on file with Olympus (DC00489968)

2) Uraoka T, Igarashi M. “Development and clinical usefulness of a unique red dichromatic imaging technology in gastrointestinal endoscopy: A narrative review.” Therapeutic Advances in Gastroenterology. 2022;15.

Keyword

EVIS X1

Content Type

Imaging Atlas

1. WLI Observation

2. RDI Mode 2 observation​

3. Injection under RDI Mode 2​

4. Injection under RDI Mode 2​

5. Dissection​

6. Bleeding​

7. RDI Mode 1​

8. Hemostasis​

9. Completion​