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Colorectal Case 30

Prof. Naohisa Yahagi

Cancer Center, Keio University Hospital, Japan

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.

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.

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

Case 29: Multifocal Anal Squamous Intraepithelial Lesions (ASIL) with low and high-grade dysplasia
Mr. Peter Borch-Johnsen Case 31: Multiple lesions in ascending colon Prof. Dr. Hu Xiao

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