High saturation red selectivity and high resolution video endoscopy for acute GI bleeding

Endoscopy in the setting of suspected acute GI bleeding can be hampered by intraluminal materials. Blood and clot can interfere with discriminating between active or inactive bleeding as well as the site of bleeding. AIM: To assess a video endoscope system with greater resolution and red color discrimination and the ability to identify the presence of blood, active bleeding, and a focal bleeding site. METHODS: The Olympus CV 140 70% larger image video system, with 60% improved resolution in the GIF-Q140 upper endoscope and 100% in the CF-Q140 lower endoscope, and processor with high saturation red color discrimination and enhancement (HSR) capability was incorporated into the GI Bleeding Team emergency mobile unit. Endoscopists and gastrointestinal assistants evaluated color discrimination, image quality, data entry, image controls (iris function; contrast; gain; image size), endoscope handling and care. Image resolution and HSR function were further evaluated to discriminate the presence or absence of blood, active from inactive bleeding, and site of bleeding. A scoring scale from 0-5, modified for performance or function assessment was used (0=dislike or not useful; 5=prefer or very useful). A 3-month evaluation period involving 281 procedures (252 upper; 80 lower) was selected. The instruments were used in emergency or urgent cases for which active bleeding was suspected. RESULTS: HSR received a median score of 3 (range 0-5) in upper and 5 (range 4-5) in lower GI procedures. Image resolution and the larger image received a median score of 5 (range 4-5) for both upper and lower procedures. HSR was uniformly ranked very useful for discriminating blood from dark secretions, especially in the colon, and not useful to confirm active bleeding or a specific bleeding site. Greater image resolution and larger image were uniformly ranked very useful for enhancing identification of angioectasias and stigmata recent hemorrhage in ulcerated lesions. CONCLUSIONS: 1. An endoscopic video system with enhanced red sensitivity for discerning blood from dark secretions is useful in situations of indeterminate bleeding. 2. Higher resolution endoscopes are appealing for improving the identification of angioectasias and non-bleeding stigmata in ulcerated lesions.