Work

Novel Image Enhancement Using Amber Color Imaging in Facilitating Endoscopic Submucosal Dissection: The First Clinical Experience

Year: 2026

Type: article

Abstract: Background and Aim Amber-red color imaging (ACI) is a new image-enhanced modality designed to improve visualization of blood vessels during gastrointestinal bleeding. Its role in endoscopic submucosal dissection (ESD) has not been evaluated. We aimed to describe ACI's utility in ESD through a first clinical series. Methods Prospective case series of eight patients undergoing upper or lower gastrointestinal ESD at a tertiary center using a novel processor with ACI capability. Endoscopists alternated between white-light imaging (WLI) and ACI. Outcomes included Likert-type score for visibility across two groups (expert and non-expert), dissection speed, and adverse events. Results Eight ESD cases (1 esophageal, 7 colorectal) were included. En bloc resection was achieved in all cases (100%), with no adverse events. Mean procedure time was 71.8 minutes (range 30–180), mean specimen size 58.8 ± 43.3 mm, and dissection speed 44.7 mm 2 /min. ACI significantly improved submucosal visibility for both experts (6.27 ± 1.33 vs 9.22 ± 0.94; P < 0.001) and non-experts (7.60 ± 0.83 vs 9.56 ± 0.62; P < 0.001). Similar improvements were observed for blood vessel recognition (experts: 7.38 ± 1.98 vs 8.89 ± 1.13; P < 0.001; non-experts: 8.00 ± 1.04 vs 9.28 ± 0.83; P=0.002). Non-experts using ACI outperformed experts using WLI (P < 0.001). Muscularis propria visualization improved only among non-experts (P = 0.020). ACI did not improve active bleeding visibility in either group. Conclusions ACI enhances submucosal visualization during ESD and may serve as a useful therapeutic adjunct.

Source: iGIE

DOI: 10.1016/j.igie.2026.08.014