Xiao-Tian Sun¹, Min Min², Yi-Liang Bi², Yang Xu², Yan Liu²

Chin Med J (Engl). 2017 May 5 Impact factor 0.957

Endoscopic submucosal dissection (ESD) has been widely applied in clinical practice for resecting gastrointestinal mucosal lesions. However, the risk of post-ESD complications is relatively high, and the bleeding is one of the most common complications after ESD, which needs timely detection and treatment. At recent, several new endoscopic imaging techniques have been developed to improve the diagnostic efficiency. Linked color imaging (LCI), which is a newly developed endoscopic technique,[1],[2] could enhance the color contrast and thus have advantage of identifying bleeding points during ESD. So far, whether the application of LCI in ESD procedure is feasible and safe has not been ever explored. In this report, we described a patient with rectal neuroendocrine tumor who was successfully treated by ESD using LCI.

The dissection was completed under WLE mode, which could clearly observe the mucosa and submucosal vessels. If the bleeding was suspected, LCI mode was used, which was easier to detect the bleeding point located in superficial submucosa [Supplementary Video 2]. The postoperative wound should be observed combining WLE and LCI mode, which could effectively handle the superficial and deep vessels and prevent postoperative bleeding.

This report demonstrated that LCI technique could be safe and effective in the application of ESD for rectal neuroendocrine tumor. LCI is a new endoscopic technique, which has a high diagnostic field. The report rarely demonstrated that the application of LCI during ESD was feasible and safe. Furthermore, the observation under LCI mode could identify the bleeding points, enabling the complete hemostasis. LCI mode is quite efficient in detecting the bleeding points during ESD, while WLE mode is recommended for the dissection procedure to avoid vascular damage. The clinical application of LCI might be further examined in future clinical trial.