title: Infrared endoscopic system for bleeding-point detection after flushing with indocyanine green solution (with videos).
abstract: BACKGROUND
  Infrared endoscopy is used to visualize vessels in the GI tract. By applying this system, we developed a new method to visualize a bleeding point during endoscopic resection.
  
  
  OBJECTIVE
  This study aimed to evaluate the ability of infrared endoscopy to detect a bleeding point during endoscopic resection and to elucidate the mechanism required for clear visualization of a bleeding point by in vitro color analysis.
  
  
  METHODS
  Observational case series.
  
  
  METHODS
  A cancer-referral center.
  
  
  METHODS
  A total of 10 bleeding sites were observed during endoscopic resection of upper-GI cancers by infrared endoscopy after flushing with indocyanine green (ICG) solution (0.125 mg/mL water).
  
  
  METHODS
  Detection of bleeding points.
  
  
  RESULTS
  Bleeding points were identified in all bleeding sites by infrared endoscopic viewing. Bleeding points were displayed in white, whereas, an ulcer bed was in blue and pooled blood was a blue-to-gray color. By in vitro color analysis, blood was white, blood twice diluted with ICG solution was dark blue, and blood 4-times diluted with ICG solution was light blue on infrared endoscopic views. Color differences with blood dilution were more obvious in an infrared endoscopic view compared with a conventional endoscopic view. Blood thickness, movement, and clotting did not influence the color differences.
  
  
  CONCLUSIONS
  Uncontrolled study.
  
  
  CONCLUSIONS
  We reported a flushing method by which we could detect all bleeding points during endoscopic resection. Clear visualization of bleeding points comes from differences in blood and ICG concentration between spurting and pooled blood.
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Ryu
authors.initials: R
authors.lastname: Ishihara
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iishi
authors.forename: Takashi
authors.initials: T
authors.lastname: Kidu
authors.forename: Sachiko
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Rika
authors.initials: R
authors.lastname: Miyoshi
authors.forename: Takuya
authors.initials: T
authors.lastname: Inoue
authors.forename: Yoji
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Koji
authors.initials: K
authors.lastname: Higashino
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
authors.forename: Masaharu
authors.initials: M
authors.lastname: Tatsuta
mesh_terms: D004396:Coloring Agents; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery*; D006801:Humans; D007208:Indocyanine Green; D007259:Infrared Rays; D019106:Postoperative Hemorrhage / Q000175:diagnosis*; D013274:Stomach Neoplasms / Q000601:surgery*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green