Endoscopic submucosal dissection and tunneling procedures using novel image-enhanced technique

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.