Visibility of early gastric cancers by texture and color enhancement imaging using a high-definition ultrathin transnasal endoscope

Abstract

We evaluated whether texture and color enhancement imaging (TXI) using a high-definition ultrathin transnasal endoscope (UTE) improves the visibility of early gastric cancer (EGC) compared with white-light imaging (WLI). This study included 31 EGCs observed by TXI mode 2 using a high-definition UTE prior to endoscopic submucosal dissection. The first outcome was to compare the color differences based on Commission Internationale de l’Eclairage L*a*b* color space between EGCs and the surrounding mucosa by WLI and TXI using the UTE (objective appearance of EGC). The second outcome was to assess the visibility of EGCs by WLI and TXI using the UTE in an image evaluation test performed on 10 endoscopists (subjective appearance of EGC). Color differences between EGCs and non-neoplastic mucosa were significantly higher in TXI than in WLI in all EGCs (TXI: 16.0 ± 10.1 vs. WLI: 10.2 ± 5.5 [mean ± standard deviation], P < 0.001). Median visibility scores evaluated by 10 endoscopists using TXI were significantly higher than those evaluated using WLI (TXI: 4 [interquartile range, 4–4] vs. WLI: 4 [interquartile range, 3–4], P < 0.001). TXI using high-definition UTE improved both objective and subjective visibility of EGCs compared with WLI.

Advanced diagnostic endoscopy in the upper gastrointestinal tract: Review of the Japan Gastroenterological Endoscopy Society core sessions

“…Dobashi et al ., 25 Abe et al ., 26 Koyama et al ., 27 and Okimoto et al 28 . reported TXI mode1 can enhance color changes and improve the visibility of SCC suspicious lesions in the pharynx and esophagus, gastric cancer, and superficial nonampullary duodenal tumor compared to WLI.…”

“…TXI is a new image-enhanced endoscopy that enhances brightness, surface irregularities such elevation or depression, and subtle color changes. Dobashi et al, 25 Abe et al, 26 Koyama et al, 27 and Okimoto et al 28 reported TXI mode1 can enhance color changes and improve the visibility of SCC suspicious lesions in the pharynx and esophagus, gastric cancer, and superficial nonampullary duodenal tumor compared to WLI.…”

Gastrointestinal: Texture and color enhancement imaging is useful for detection of small gastric adenocarcinoma of fundic‐gland type

“…Moreover, the majority of GA‐FG are small and have a similar or pale color in comparison to surrounding mucosa with poorly demarcated borders, which may increase the difficulty in detection of these lesions 2,3 . TXI is a novel image enhancement technique, which increases the difference in contrast in surface morphology and color of the mucosa and has the potential to improve the detection of superficial lesions in the stomach 4–6 . TXI combines retinex‐based processing modifications and color enhancements to enhance texture, brightness and color in an image, while maintaining image naturalness seen in WLI 7 .…”

“…2,3 TXI is a novel image enhancement technique, which increases the difference in contrast in surface morphology and color of the mucosa and has the potential to improve the detection of superficial lesions in the stomach. [4][5][6] TXI combines retinex-based processing modifications and color enhancements to enhance texture, brightness and color in an image, while maintaining image naturalness seen in WLI. 7 This image enhancement technology has been proposed to improve detection of subtle tissue differences, such as that seen in GA-FG, where the superficial layer is covered with non-neoplastic epithelium, 2 resulting in no clear demarcation line, microsurface or microvessel irregularity.…”

Visibility of esophageal squamous cell carcinoma under iodine staining on texture and color enhancement imaging

“… 17 The effectiveness of TXI compared with WLI in improving the visibility of gastric and colorectal cancer has been reported. 18 , 19 , 20 , 21 , 22 , 23 Improved visibility on TXI for ESCC has also been reported 24 ; however, the effects of TXI when iodine staining is used for ESCC have not been evaluated. Here, we preliminary examined the effects of TXI on improving the endoscopic visibility of ESCC under 1% iodine staining.…”