Red Dichromatic Imaging (RDI) is a novel image-enhancement modality designed to highlight bleeding points more clearly during endoscopic procedures. Although early studies suggest improved visualization, its overall clinical impact across different bleeding scenarios has not been quantified. This study aimed to evaluate the effect of RDI compared with White Light Imaging (WLI) on bleeding visibility and hemostasis performance.

Comparative studies assessing RDI versus WLI during active gastrointestinal bleeding or bleeding-related interventions were systematically reviewed.Random-effects meta-analyses were performed for visibility scores (standardized mean difference, SMD) and for hemostasis or treatment time (mean difference, MD). Three studies reported visibility outcomes (n=175 observations) and two studies provided procedural time data (n=2,064 hemostatic actions).

RDI significantly improved blee

ding visibility compared with WLI (SMD 0.79; 95% CI 0.56–1.02; p<0.00001; I²=7%). Overall hemostasis/treatment time was not significantly different between modalities (MD −0.13 min; 95% CI −10.55 to 10.30; p=0.98; I²=83%). However, in variceal EIS/EISL procedures RDI markedly shortened treatment time (MD −4.67 min), while ESD-related hemostasis times were comparable.

RDI provides a consistent and clinically meaningful improvement in bleeding visibility. Although overall hemostasis time was not reduced, RDI substantially accelerates variceal therapy. These findings support RDI as an emerging tool for enhancing real-time endoscopic bleeding management.