Amber-red color imaging for enhanced anatomical structures recognition in third-space endoscopy: a prospective video-based study
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Updated: Feb 2, 2026

Deep Vascular Imaging in the Eye with Flow-Enhanced Ultrasound
Published on: October 4, 2021
Roberta Maselli1, Roberto de Sire2, Vincenzo Vadalà1
1Endoscopy Unit, Gastroenterology Department, Humanitas Research Hospital IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Background And Aims:
Amber-red color imaging (ACI) is a novel image-enhanced endoscopic modality designed to improve visualization of blood-rich and submucosal structures. This study aimed to evaluate whether ACI improves, in a clinical setting, the clarity of identification of submucosal vessels and submucosal and muscle layers compared with white-light imaging (WLI) in a standardized, video-based setting.
Methods:
In this prospective video-based study, third-space endoscopy clips, including endoscopic submucosal dissections (ESDs) and peroral endoscopic myotomies (POEMs), were analyzed. Each clip included matched WLI and ACI segments in randomized order. Six expert and 6 nonexpert endoscopists independently rated vessel and submucosal and muscle layer clarity on a 10-point Likert scale.
Results:
Clips from 35 ESDs and 20 POEMs were analyzed. For submucosal vessels, mean scores improved from 7.33 ± 0.89 to 8.55 ± 0.85 for nonexperts and from 7.96 ± 0.86 to 9.63 ± 0.51 for experts (both P < .001); nonexperts with ACI outperformed experts with WLI (P < .01). For the submucosal layer, nonexperts improved from 6.37 ± 1.51 to 8.14 ± 1.29, and experts improved from 7.82 ± 0.87 to 9.80 ± 0.40 (both P < .001), with nonexperts achieving expert WLI performance (P = .2). For the muscle layer, nonexperts improved from 5.31 ± 1.16 to 7.12 ± 1.17, and experts improved from 7.75 ± 0.73 to 9.51 ± 0.57 (both P < .001).
Conclusions:
ACI enhances recognition of submucosal vessels and submucosal and muscle layers in ESD and POEM, benefiting both experts and nonexperts, and may serve as a valuable adjunct in third-space endoscopy.
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