Effectiveness of Gel‐immersion Endoscopic Injection Sclerotherapy Under Texture and Color Enhancement Imaging for Esophageal Varices: A Comparison of Variceal Visibility Under Gel With White Light Imaging

Objective 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. Methods 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. Results 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%, p = 0.54). However, injection into the afferent vessels was significantly more successful with GI‐EIS under TXI (87.5% vs. 43.8%, p < 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; p < 0.01). Conclusion 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.