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Esophageal Case 1

Dr. D Nageshwar Reddy

AIG Hospitals, Hyderabad, India

Procedure Information


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 Mode2
RDI (Red dichromatic imaging) clearly showing vessels in deep mucosa or submucosa compared with white-light imaging

#RDI Mode2
RDI 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 local injection of saline solution with indigo carmine.

#RDI 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. 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 because amber light absorption is greater at the bleeding point, which has a higher hemoglobin concentration than the surrounding area where blood has been diluted.

Overall Comment

RDI enhances the visibility of deep blood vessels and bleeding sources. It leads to early identification of bleeding points and quicker hemostasis. It also reduces the stress experienced by the endoscopist performing POEM. However, prospective studies looking into the utility of RDI in POEM are required.

* Specifications, design and accessories are subject to change without any notice or obligation on the part of the manufacturer