Kato Tsunetaka, Hikichi Takuto, Nakamura Jun, Hashimoto Minami, Yanagita Takumi, Otsuka Mitsuru, Nemoto Daiki, Suzuki Rei, Sugimoto Mitsuru, Asama Hiroyuki, Sato Kentaro, Shimizu Hiroshi, Osawa Kento, Ohira Rei, Kobayakawa Masao, Ohira Hiromasa
Department of Endoscopy Fukushima Medical University Hospital Fukushima Japan.
Department of Gastroenterology Fukushima Medical University School of Medicine Fukushima Japan.
DEN Open. 2025 Sep 22;6(1):e70201. doi: 10.1002/deo2.70201. eCollection 2026 Apr.
Gel-immersion endoscopic injection sclerotherapy (GI-EIS) addresses the technical challenges in intravariceal injection for esophageal varices (EVs). However, gel accumulation may obscure the variceal morphology. Thus, we developed GI-EIS under texture and color enhancement imaging (TXI) and evaluated its effectiveness.
This study included EV patients who underwent primary prophylactic intravariceal EIS. Patients were divided into GI-EIS under TXI and conventional EIS groups. Primary outcomes were the success rates of intravariceal sclerosant injection and sclerosant injection into the afferent vessels. Secondary outcomes included the visibility score of EV morphology under TXI compared with white light imaging (WLI) during gel-immersion and luminance gradient across the EVs.
Overall, 32 patients (16 in each group) were evaluated. The success rate of intravariceal sclerosant injection was comparable between GI-EIS under TXI and conventional EIS (93.8% vs. 87.5%, = 0.54). However, injection into the afferent vessels was significantly more successful with GI-EIS under TXI (87.5% vs. 43.8%, < 0.01). The visibility score of the variceal morphology under TXI was consistently five points in all cases. The luminance gradient was significantly higher under TXI than under WLI (TXI vs. WLI; 0.95 vs. 0.68; < 0.01).
GI-EIS under TXI provided improved visualization of variceal morphology and enhanced success of injection into afferent vessels, suggesting that TXI may optimize the therapeutic performance of GI-EIS for EV.
凝胶浸润内镜注射硬化疗法（GI-EIS）解决了食管静脉曲张（EV）曲张静脉内注射的技术难题。然而，凝胶积聚可能会模糊曲张静脉的形态。因此，我们在纹理和颜色增强成像（TXI）技术下开展了GI-EIS，并评估其有效性。
本研究纳入了接受一级预防性曲张静脉内硬化治疗的EV患者。患者被分为TXI技术下的GI-EIS组和传统硬化治疗组。主要结局指标为曲张静脉内硬化剂注射成功率和向流入血管内注射硬化剂的成功率。次要结局指标包括在凝胶浸润过程中，TXI技术下EV形态的可视性评分与白光成像（WLI）的比较，以及EV上的亮度梯度。
总共评估了32例患者（每组16例）。TXI技术下的GI-EIS组与传统硬化治疗组的曲张静脉内硬化剂注射成功率相当（93.8%对87.5%，P = 0.54）。然而，TXI技术下的GI-EIS组向流入血管内注射硬化剂的成功率显著更高（87.5%对43.8%，P < 0.01）。在所有病例中，TXI技术下曲张静脉形态的可视性评分始终为5分。TXI技术下的亮度梯度显著高于WLI技术下的亮度梯度（TXI对WLI；0.95对0.68；P < 0.01）。
TXI技术下的GI-EIS改善了曲张静脉形态的可视化，并提高了向流入血管内注射硬化剂的成功率，这表明TXI技术可能会优化GI-EIS对EV的治疗效果。
