Improvement in the Visibility of Submucosal Layers and Vessels with Amber-Red Color Imaging in Colorectal Endoscopic Submucosal Dissection

Yoshida N 1 , Rani RA 2 , Inoue K 3 , Kobayashi R 3 , Iwai N 3 , Dohi O 3 Show all authors , Guillén FRD 4 , Puentes GM 4 , Gonzalez GRL 5 , Valdebenito PS 5 , López-Köstner F 6 , Jayaraman T 2 , Hirose R 7 , Ban The FK 8 , Li JW 8

Affiliations 

  • 1 Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan. naohisa@koto.kpu-m.ac.jp
  • 2 Gastroenterology Unit, Faculty of Medicine, Universiti Teknologi MARA, Bandar Puncak Alam, Selangor, Malaysia
  • 3 Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
  • 4 Endoscopy Unit, Clínica Universidad de los Andes, Santiago, Chile
  • 5 Diagnostic and Therapeutic Digestive Endoscopy, Universidad de los Andes, Santiago, Chile
  • 6 Cancer Center, Clínica Universidad de los Andes, Santiago, Chile
  • 7 Department of Infectious Disease, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
  • 8 Department of General Medicine, Division of Medicine and Inpatient Care, Sengkang General Hospital, Sengkang, Singapore
Dig Dis Sci, 2026 Jul;71(7):2939-2947.
PMID: 41689686 DOI: 10.1007/s10620-026-09736-6

Abstract

BACKGROUND AND AIM: Amber-red colour imaging (ACI) (Fujifilm), a novel observational mode, was developed to visualise submucosal vessels. This study evaluated vessel and submucosal layer visibility using ACI during colorectal endoscopic submucosal dissection (ESD).

METHODS: This observational study reviewed consecutive patients undergoing colorectal ESD from January 2021 to June 2025. Therapeutic outcomes of 72 ACI cases were compared with 505 white light imaging (WLI) cases. The primary outcome of this study was the mean number of intraoperative bleeding (IB) events during ESD between cases with ACI and those with WLI. The secondary outcomes were various therapeutic outcomes of ESD. Additionally, fifteen endoscopists from four countries (seven experts, eight non-experts) evaluated the visibility in ACI and WLI images during ESD using a four-point scale (Score 1 = poor to Score 4 = excellent).

RESULTS: Among 72 cases (mean age: 67.3 ± 11.9 years, male proportion: 48.6%), the en bloc resection rate was 98.6%. The ACI group showed fewer IB events than the WLI group (2.0 ± 2.5 vs 2.7 ± 3.4, p = 0.040), significant only among non-experts (1.5 ± 2.0 vs. 2.6 ± 3.1, p = 0.009). Regarding image evaluations, ACI achieved higher visibility scores (median [interquartile]) for vessels (4 [3-4] vs. 3 [2-3], p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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