title: A pilot study using an infrared imaging system in prevention of post-endoscopic submucosal dissection ulcer bleeding.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) for superficial gastric neoplasm is a curative method. The aim of this study was to detect potential nonbleeding visible vessels (NBVVs) by using an infrared imaging (IRI) system.
  
  
  METHODS
  A total of 24 patients (25 lesions) were consecutively enrolled between March 2010 and December 2010. The day after ESD, endoscopist A (K.M.), who was blinded to the actual procedure of ESD, performed esophagogastroduodenoscopy (EGD) of the post-ESD ulcer base using the IRI system. Endoscopist A marked gray/blue points in the hard-copy images with the IRI system. After the first procedure, endoscopist B (Y.Y.), who was blinded to the results recorded by endoscopist A, performed a second EGD with white light endoscopy and administered water-jet pressure with the maximum level of an Olympus flushing pump onto the post-ESD ulcer base. This test can cause iatrogenic bleeding via application of pressure to NBVV in the post-ESD ulcer.
  
  
  RESULTS
  The IRI system detected 58 gray points and 71 blue points. The post-ESD ulcer was divided into the central area and the peripheral area. There were 14 gray points (24 %) in the central area and 44 gray points (76 %) in the peripheral area. There were 19 blue points (27 %) in the central area and 52 blue points (73 %) in the peripheral area. There was no significant difference when comparing the distribution of gray points and blue points. Bleeding occurred with a water-jet pressure in 11 of 58 gray points and in none of the blue points (P = 0.000478). Among the gray points, bleeding in response to a water-jet pressure occurred in 2 points in the central area and in 9 points in the peripheral area.
  
  
  CONCLUSIONS
  The IRI system detects visible vessels (VVs) that are in no need of coagulation as blue points, and VVs have a potential risk of bleeding as gray points.
authors: Department of Endoscopy, Katsushika Medical Center, The Jikei University School of Medicine, 6-41-2 Katsushika-ku, Tokyo, 125-8506, Japan, yukinaga29@jikei.ac.jp.
authors: Yukinaga
authors: Y
authors: Yoshida
authors: Koji
authors: K
authors: Matsuda
authors: Naoto
authors: N
authors: Tamai
authors: Kai
authors: K
authors: Yoshizawa
authors: Toshiki
authors: T
authors: Nikami
authors: Haruya
authors: H
authors: Ishiguro
authors: Hisao
authors: H
authors: Tajiri
mesh_terms: D004210:Dissection / Q000009:adverse effects / Q000379:methods; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D010865:Pilot Projects; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000517:prevention & control*; D013055:Spectrophotometry, Infrared / Q000379:methods*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D014456:Ulcer / Q000175:diagnosis*
references: Surg Technol Int. 2010 Apr;19:91-6
references: 20437351
references: Endoscopy. 2011 Mar;43(3):236-9
references: 21108179
references: Clin Res Hepatol Gastroenterol. 2011 Apr;35(4):288-94
references: 21458402
references: Endoscopy. 1994 Oct;26(8):686-9
references: 7859679
references: Gastrointest Endosc. 2011 Feb;73(2):413-4; author reply 414-5
references: 21295659
references: Gastrointest Endosc. 1995 Mar;41(3):218-24
references: 7789680
references: Endoscopy. 2008 Mar;40(3):179-83
references: 18322872
references: Gastrointest Endosc. 2010 Aug;72(2):444-8
references: 20541199
references: Gastrointest Endosc. 2010 Aug;72(2):413-8
references: 20430383
references: Endoscopy. 2010 Dec;42(12):1037-44
references: 20972955
references: Gastric Cancer. 2007;10(1):1-11
references: 17334711
references: J Gastroenterol Hepatol. 2004 Jan;19(1):13-7
references: 14675237
references: J Gastroenterol. 2006 Oct;41(10):929-42
references: 17096062
references: J Gastroenterol. 2010;45(1):30-6
references: 19760133
references: Gastrointest Endosc. 2009 Jun;69(7):1228-35
references: 19249769
references: Gut. 1994 Oct;35(10):1389-93
references: 7959193
references: Gastrointest Endosc. 2003 Mar;57(3):336-42
references: 12612512
references: Scand J Gastroenterol. 2009;44(11):1370-6
references: 19891589
references: Gastrointest Endosc. 2009 Feb;69(2):350-5
references: 19185696
references: Dig Endosc. 2009 Jul;21 Suppl 1:S4-6
references: 19691732
references: Scand J Gastroenterol. 2010 Sep;45(9):1127-8
references: 20443747