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Amber-red color imaging for enhanced anatomical structures recognition in third-space endoscopy: a prospective
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.
Gastrointestinal Endoscopy
|January 31, 2026
Summary
Amber-red color imaging (ACI) significantly improves the visualization of submucosal vessels and layers during endoscopic submucosal dissections (ESD) and peroral endoscopic myotomies (POEM). This novel technique enhances clarity for both expert and non-expert endoscopists in third-space endoscopy.
Area of Science:
- Gastroenterology
- Endoscopic Imaging
- Surgical Visualization
Background:
- Amber-red color imaging (ACI) is a new image-enhanced endoscopy technique.
- ACI aims to improve visualization of blood-rich and submucosal structures.
Purpose of the Study:
- To evaluate if ACI enhances identification of submucosal vessels, submucosal, and muscle layers.
- Comparison of ACI with white light imaging (WLI) in a clinical setting.
Main Methods:
- Prospective video-based study analyzing third-space endoscopy clips (ESD and POEM).
- Matched WLI and ACI segments were randomized and rated by experts and non-experts on clarity.
- A 10-point Likert scale was used to assess vessel, submucosal, and muscle layer clarity.
Main Results:
- ACI significantly improved submucosal vessel clarity for non-experts (7.33 to 8.55) and experts (7.96 to 9.63).
- Submucosal layer clarity improved with ACI for non-experts (6.37 to 8.14) and experts (7.82 to 9.80).
- Muscle layer clarity also showed significant improvement with ACI for both groups.
Conclusions:
- ACI enhances recognition of key structures in ESD and POEM procedures.
- The benefits of ACI extend to both expert and non-expert endoscopists.
- ACI is a valuable adjunct for third-space endoscopy.
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