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CC BY 4.0 · Endosc Int Open 2025; 13: a27142766
DOI: 10.1055/a-2714-2766
Original article

Image-enhanced endoscopy improves visibility of endoscopic images in individuals with color vision deficiency

Autoren

  • Akiko Ohno 

    1   Department of Gastroenterology and Hepatology, Kyorin University, Tokyo, Japan (Ringgold ID: RIN12912)

  • Jun Miyoshi

    1   Department of Gastroenterology and Hepatology, Kyorin University, Tokyo, Japan (Ringgold ID: RIN12912)

  • Mitsunori Kusuhara 

    1   Department of Gastroenterology and Hepatology, Kyorin University, Tokyo, Japan (Ringgold ID: RIN12912)
    2   Endoscopy Division, National Cancer Center Japan, Chuo, Japan (Ringgold ID: RIN13874)

  • Yoko Jinbo

    1   Department of Gastroenterology and Hepatology, Kyorin University, Tokyo, Japan (Ringgold ID: RIN12912)

  • Ryosuke Kaji

    1   Department of Gastroenterology and Hepatology, Kyorin University, Tokyo, Japan (Ringgold ID: RIN12912)

  • Takahiro Shirakawa

    1   Department of Gastroenterology and Hepatology, Kyorin University, Tokyo, Japan (Ringgold ID: RIN12912)

  • Moegi Watanabe

    1   Department of Gastroenterology and Hepatology, Kyorin University, Tokyo, Japan (Ringgold ID: RIN12912)

  • Shiori Tsubata

    1   Department of Gastroenterology and Hepatology, Kyorin University, Tokyo, Japan (Ringgold ID: RIN12912)

  • Ryutaro Sumi

    1   Department of Gastroenterology and Hepatology, Kyorin University, Tokyo, Japan (Ringgold ID: RIN12912)

  • Minoru Matsuura

    1   Department of Gastroenterology and Hepatology, Kyorin University, Tokyo, Japan (Ringgold ID: RIN12912)

  • Koichi Iga

    3   Color Universal Design Organization, Tokyo, Japan

  • Masataka Okabe

    4   Department of Anatomy, Jikei University School of Medicine, Minato, Japan (Ringgold ID: RIN12839)

  • Tadakazu Hisamatsu 

    1   Department of Gastroenterology and Hepatology, Kyorin University, Tokyo, Japan (Ringgold ID: RIN12912)

Gefördert durch: JSPS KAKENHI Grant-in-Aid for Scientific Research(C) JP 25K16017
Gefördert durch: The Kyorin Medical Society Research Grant

Clinical Trial:

Registration number (trial ID): UMIN000054679, Trial registry: UMIN Japan (http://www.umin.ac.jp/english/), Type of Study: cross-sectional observational study


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Abstract

Background and study aims

Color vision deficiency (CVD) may affect perception of color information in gastrointestinal endoscopy. However, the color-universal concept in endoscopy remains underappreciated. We hypothesized that image-enhanced endoscopy (IEE) could improve object/lesion visibility regardless of CVD and tested this hypothesis with volunteers of varying color vision characteristics.

Methods

Sixty objects/lesions (20 each of submucosal vessels during colorectal endoscopic submucosal dissection, superficial esophageal cancer, and early gastric cancer) were evaluated. Images with WLI and IEE (red dichromatic imaging [RDI], narrow-band imaging [NBI], or indigo carmine) were assessed for each object/lesion. Twenty evaluators (9 with general color vision: Type C and 11 with two types of CVD [7 with protanopia: Type P and 4 with deuteranopia: Type D]) scored vessel and lesion visibility using a four-level scale.

Results

RDI significantly improved the visibility of submucosal vessels in Types P and D (P < 0.0001) compared with WLI, but not in Type C. NBI significantly improved visibility of superficial esophageal cancer compared with WLI in all color vision types (P < 0.0001). Indigo carmine significantly improved visibility of early gastric cancer compared with WLI in all color vision types (P < 0.0001). Although visibility scores under WLI were significantly higher in Type C compared with Types P and D for all objects/lesions, intergroup differences appeared smaller under IEE due to improved visibility in Types P and D.

Conclusions

IEE improves visibility of objects/lesions where color information plays a role in detection, regardless of CVD.

Keywords

Endoscopy Upper GI Tract - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE) - Endoscopy Lower GI Tract - Quality and logistical aspects - Quality management


Publikationsverlauf

Eingereicht: 18. Februar 2025

Angenommen nach Revision: 02. August 2025

Accepted Manuscript online:
30. September 2025

Artikel online veröffentlicht:
06. November 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/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Akiko Ohno, Jun Miyoshi, Mitsunori Kusuhara, Yoko Jinbo, Ryosuke Kaji, Takahiro Shirakawa, Moegi Watanabe, Shiori Tsubata, Ryutaro Sumi, Minoru Matsuura, Koichi Iga, Masataka Okabe, Tadakazu Hisamatsu. Image-enhanced endoscopy improves visibility of endoscopic images in individuals with color vision deficiency. Endosc Int Open 2025; 13: a27142766.
DOI: 10.1055/a-2714-2766
 

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