Enhanced Esophageal Cancer Detection Using Spectrum‐Aided Vision Enhancer: A Comparative Study of White Light Imaging, Narrow‐Band Imaging, and Algorithmic Narrow‐Band Imaging‐Like Imaging

ABSTRACT Background and Aims Esophageal squamous cell carcinoma (ESCC) detection is crucial for improving survival. While narrow‐band imaging (NBI) improves mucosal visualization, limitations remain. We evaluated the diagnostic performance of the Spectrum‐Aided Vision Enhancer (SAVE), an algorithmic NBI‐like technology reconstructed from white light imaging (WLI). Methods We conducted a retrospective, image‐based exploratory feasibility study to descriptively evaluate the diagnostic performance of WLI, NBI, and SAVE. A dataset of 1350 still endoscopic images (450 each for WLI, NBI, and SAVE) across normal mucosa, dysplasia, and ESCC stages from 158 patients was blindly reviewed by three endoscopists with different experience levels (3, 5, and 15 years). Diagnostic metrics included sensitivity, specificity, accuracy, and reading time. Results For ESCC, SAVE demonstrated diagnostic performance metrics (sensitivity: 0.81–0.97, specificity: 0.85–0.96) that were numerically similar to WLI and NBI. For dysplasia detection, SAVE had lower observed sensitivity (0.39–0.62) compared to NBI (0.55–0.85) across all observers, representing a clinical limitation for precancerous screening in its current format. Mean per‐image reading times were similar across WLI, NBI, and SAVE. Conclusions In this retrospective study, SAVE showed diagnostic potential for ESCC, with observed diagnostic performance metrics numerically similar to those of WLI and NBI in this exploratory dataset, but lacked sensitivity for dysplasia. These findings are hypothesis‐generating and warrant further prospective, multicenter validation to refine the algorithm for early cancer detection.