Abstract
OBJECTIVES: Recently, the incidence of Helicobacter pylori-uninfected gastric cancers, such as gastric epithelial neoplasm of fundic-gland mucosa lineage (GEN-FGML), has increased with the widespread use of eradication therapy. Because the detection and endoscopic diagnosis of GEN-FGML are difficult, an effective observation method in screening endoscopy is required. We investigated whether texture and color enhancement imaging (TXI) improved the visibility of GEN-FGML compared with white light imaging (WLI). METHODS: In this single-center prospective clinical study, 50 GEN-FGML lesions (35 patients) treated at our hospital between October 2020 and June 2023 were analyzed. The endoscopic images of GEN-FGML obtained using WLI, TXI mode 1 (TXI-1), TXI mode 2 (TXI-2), and narrow-band imaging were compared by 10 endoscopists. We analyzed the visibility score and inter-rater reliability (intraclass correlation coefficient and conducted an objective evaluation based on L* a* b* color values and the color difference (ΔE*) in the CIE LAB color space system. RESULTS: Histologically, GEN-FGML was classified as gastric adenocarcinoma of fundic-gland type (n = 45) and gastric adenocarcinoma of fundic-gland mucosa type (n = 5). The total visibility score for all endoscopists was significantly higher for TXI than for WLI (p < 0.01); and for TXI-1 than for TXI-2 (p < 0.01). The intraclass correlation coefficients for TXI-1 and TXI-2 were "almost perfect" and "substantial," respectively, for all endoscopists. ΔE* was significantly higher for TXI than for WLI (p < 0.01). CONCLUSIONS: TXI improved the visibility of GEN-FGML for all endoscopists compared with WLI when evaluated subjectively and objectively.