Endoscopic Submucosal Dissection for Esophageal Squamous Cell Carcinoma With Varices Using Red Dichromatic Imaging

A 66-year-old man with alcoholic liver cirrhosis, classified as Child-Pugh B, was referred for treatment of superficial esophageal squamous cell carcinoma. Endoscopy revealed enlarged and tortuous esophageal varices (F2) under the lesion (Figure A). Endoscopic variceal ligation was performed on the anal side of the lesion. Two weeks thereafter, endoscopic submucosal dissection (ESD) was performed using full-time red dichromatic imaging (RDI) (Supplementary Video 1). RDI facilitated the identification of subepithelial vessels and prevented vascular damage during submucosal injection. Dilated vessels could be identified during circumferential mucosal incision (Figure B) and submucosal dissection more distinctly than white light imaging (Figure C, D), enabling accurate preventive coagulation using hemostatic forceps. No major bleeding was observed during the procedure and en bloc resection was achieved. The patient was discharged 4 days after ESD without any adverse events. Histopathological examination revealed squamous cell carcinoma confined to the epithelial layer with negative margins.