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Submucosal technology for safe third space procedures: Amber-Red Color Imaging-guided Gastric-PerOral Endoscopic myotomy for idiopathic refractory gastroparesis

Year: 2025

Type: article

Abstract: Refractory gastroparesis is a chronic motility disorder characterized by delayed gastric emptying in the absence of mechanical obstruction. For patients unresponsive to maximal medical therapy, gastric peroral endoscopic myotomy (G-POEM) has emerged as a minimally invasive treatment targeting pyloric dysfunction [ 1 ] [ 2 ]. We report the case of a 60-year-old man with idiopathic refractory gastroparesis referred for G-POEM. Radiological and motility studies confirmed delayed gastric emptying without evidence of obstruction. The procedure was performed using the Fujifilm EG-860R gastroscope (outer diameter 8.9 mm, working channel 2.8 mm) and the ELUXEO 8000 processor. HybridKnife T-type (Erbe Elektromedizin GmbH, Tübingen, Germany) was used for all procedural steps. Mucosotomy was performed along the greater curvature, followed by submucosal tunneling and full-thickness myotomy of the circular fibers of the pyloric sphincter [ 3 ]. The mucosal entry was closed using standard endoscopic clips ([ Video 1 ]). Download Identification of tissue planes using ACI during G-POEM. Both submucosal space and vessels are emphasized to facilitate orientation during tunneling and myotomy.Video 1 Amber-Red Color Imaging (ACI), Fujifilm’s latest image-enhancement modality for third-space endoscopy, was used throughout the procedure. ACI highlights blood color contrast and improves visualization of submucosal vasculature and tissue planes, particularly the muscle, while maintaining white-light brightness [ 4 ] [ 5 ]. This facilitated identification of anatomical layers and improved orientation during tunneling and myotomy ([ Fig. 1 ]). Fig. 1 G-POEM procedure using Amber-Red Color Imaging (ACI) and a Fujifilm EG-860R gastroscope with HybridKnife T-type. The procedure was completed uneventfully. The patient was discharged 6 hours postprocedure with no symptoms and reported clinical improvement at follow-up. This case demonstrates the utility of ACI in enhancing visualization during G-POEM, supporting safe and efficient dissection. The integration of advanced imaging, multifunctional tools, and novel scopes may contribute to standardized and streamlined third-space endoscopy. Endoscopy_UCTN_Code_TTT_1AQ_2AD_3AZ Endoscopy E-Videos https://eref.thieme.de/e-videos E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos . Publication History Article published online: 04 September 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Source: Endoscopy

DOI: 10.1055/a-2673-9263