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DOI: 10.1055/a-2673-9263
Submucosal technology for safe third space procedures: Amber-Red Color Imaging-guided Gastric-PerOral Endoscopic myotomy for idiopathic refractory gastroparesis
The publication fee for this work was covered by the Italian Ministry of Health’s Ricerca Corrente funding to the IRCCS Humanitas Research Hospital.
Refractory gastroparesis is a chronic motility disorder characterized by delayed gastric emptying in the absence of mechanical obstruction. For patients unresponsive to maximal medical therapy, gastric peroral endoscopic myotomy (G-POEM) has emerged as a minimally invasive treatment targeting pyloric dysfunction [1] [2]. We report the case of a 60-year-old man with idiopathic refractory gastroparesis referred for G-POEM. Radiological and motility studies confirmed delayed gastric emptying without evidence of obstruction. The procedure was performed using the Fujifilm EG-860R gastroscope (outer diameter 8.9 mm, working channel 2.8 mm) and the ELUXEO 8000 processor. HybridKnife T-type (Erbe Elektromedizin GmbH, Tübingen, Germany) was used for all procedural steps. Mucosotomy was performed along the greater curvature, followed by submucosal tunneling and full-thickness myotomy of the circular fibers of the pyloric sphincter [3]. The mucosal entry was closed using standard endoscopic clips ([Video 1]).
Identification of tissue planes using ACI during G-POEM. Both submucosal space and vessels are emphasized to facilitate orientation during tunneling and myotomy.Video 1Amber-Red Color Imaging (ACI), Fujifilm’s latest image-enhancement modality for third-space endoscopy, was used throughout the procedure. ACI highlights blood color contrast and improves visualization of submucosal vasculature and tissue planes, particularly the muscle, while maintaining white-light brightness [4] [5]. This facilitated identification of anatomical layers and improved orientation during tunneling and myotomy ([Fig. 1]).
The procedure was completed uneventfully. The patient was discharged 6 hours postprocedure with no symptoms and reported clinical improvement at follow-up.
This case demonstrates the utility of ACI in enhancing visualization during G-POEM, supporting safe and efficient dissection. The integration of advanced imaging, multifunctional tools, and novel scopes may contribute to standardized and streamlined third-space endoscopy.
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Publication History
Article published online:
04 September 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
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- 5 Funasaka K, Horiguchi N, Yamada H. et al. Endoscopic submucosal dissection of early gastric cancer using a novel image-enhanced endoscopy: amber-red color imaging. Endoscopy 2024; 56: E640-E641