Amber-red color imaging in third-space endoscopy and ESD: preliminary Western experience

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Medical Imaging

Background:

• Third-space endoscopy, including endoscopic submucosal dissection (ESD), demands precise visualization for safe and effective tissue resection.
• Challenges in ESD include maintaining spatial orientation, identifying critical structures like vessels, and accurately defining dissection planes, particularly in fibrotic tissues.

Purpose of the Study:

• To evaluate the utility of augmented reality visualization (ACI) in enhancing spatial orientation, vessel identification, and dissection accuracy during third-space endoscopy/ESD.
• To assess the impact of ACI on the clarity of dissection planes and the risk of inadvertent injury.

Main Methods:

• A qualitative series of five endoscopic submucosal dissection (ESD) cases utilizing augmented reality visualization (ACI).
• ACI provided enhanced visualization of submucosal layers, vessels, and dissection planes.
• Observations focused on plane recognition, spatial orientation, vessel definition, and dissection accuracy.

Main Results:

• ACI improved submucosal plane recognition by rendering the submucosa light blue, distinct from mucosa and muscularis.
• Vessel visualization was enhanced in red, aiding anticipatory coagulation and dissection accuracy.
• The dissection plane was more evident in gastric and rectal ESD, especially in narrow/fibrotic areas, reducing injury risk.
• All five cases were completed without adverse events.

Conclusions:

• Augmented reality visualization (ACI) shows promise in improving spatial orientation, vessel anticipation, plane maintenance, and dissection accuracy in third-space endoscopy/ESD.
• Further prospective, multi-operator studies with objective metrics are warranted to validate these hypothesis-generating findings.