Esophageal Case 1
Dr. D Nageshwar Reddy
AIG Hospitals, Hyderabad, India
Disclaimer:
- NBI, RDI and TXI Technologies are not intended to replace histopathological sampling as a means of diagnosis
- NBI, RDI and TXI Technologies are 510(k) cleared in the United State. This case study is being furnished to provide example of NBI, RDI and TXI technology use. The GIF-EZ1500 used in this case is not available in the US market at this time, nor is there an established time for it’s release. The safety and effectiveness of this product and/or the use of these products has not yet been established in the United States market.
- The positions and statements made herein by Dr. D Nageshwar Reddy are based on Dr. D Nageshwar Reddy’s experiences, thoughts and opinions. As with any product, results may vary, and the techniques, instruments, and settings can vary from facility to facility. The content hereof should not be considered as a substitute for carefully reading all applicable labeling, including the Instructions for Use. Please thoroughly review the relevant user manual(s) for instructions, risks, warnings, and cautions. Techniques, instruments, and setting can vary from facility to facility. It is the clinician’s decision and responsibility in each clinical situation to decide which products, modes, medications, applications, and settings to use.
- 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)
Scope : GIF-EZ1500
Case : Peroral endoscopic myotomy (POEM)
Organ : Esophagus
Patient Information : M, 40
Medical History : 1-year history of difficulty in swallowing liquids and solids. His Eckhart’s score was 6 of 12. EGD showed dilated esophagus with liquid stasis and mild resistance noted across the gastroesophageal junction. Esophageal manometry showed elevated integrated relaxation pressure with panesophageal pressurization (achalasia cardia type II)
Case video
＃RDI™ Technology Mode2 RDI (Red dichromatic imaging) technology clearly showing vessels in deep mucosa or submucosa compared with white-light imaging.
#RDI™ Technology Mode2 RDI technology mode 1 and mode 2 were used during POEM. Mucosal incision and entry into the submucosal tunnel are crucial steps in POEM. To achieve a clean mucosal incision, it is desirable to avoid deep blood vessels during the cut. Mode 2 was used to identify the deep blood vessels after submucosal injection of normal saline.
#RDI ™ Technology Mode1 There was an inadvertent injury to the blood vessel, leading to bleeding. White-light imaging showed pooling of blood without clear delineation of the bleeding point. Because of the differential absorption of amber light, the bleeding point was better identified with RDI™ Technology. Identification of the bleeding point is difficult with an oozing type of bleed under white-light imaging. The bleeding point appears a deeper yellow than the surrounding area under RDI™ Technology because amber light absorption is greater at the bleeding point, which has a higher hemoglobin concentration than the surrounding area where blood has been diluted1,2.
Overall Comment
RDI™ technology enhances the visibility of deep blood vessels and bleeding sources1.
Identification of bleeding spots through RDI technology makes hemostasis quick and easy. Therefore, RDI technology may help to reduce stress and procedure time for endoscopists performing POEM1. However, prospective studies looking into the utility of RDI in POEM are required.
1) data on file Data on file with Olympus (DC00489968)
2) Development and clinical usefulness of a unique red dichromatic imaging technology in gastrointestinal endoscopy: A narrative review
(https://journals.sagepub.com/doi/10.1177/1756284 8221118302)
* Specifications, design and accessories are subject to change without any notice or obligation on the part of the manufacturer
