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Background <p>Texture and color enhancement imaging (TXI) is an image-enhanced endoscopy technique that facilitates gastric lesion visualization by enhancing color and texture. This study aimed to assess the tumor extent using a combination of acetic acid (AA) and indigo carmine (IC) staining (AA + IC staining) with TXI for gastric tumors.</p> Methods <p>Between March 2022 and February 2023, we prospectively enrolled 50 consecutive patients with gastric tumors treated with endoscopic resection at Toho University Omori Medical Center. We compared color differences (ΔEs) between neoplastic lesions and surrounding mucosa using white light imaging (WLI) and TXI (modes 1 and 2). Each lesion was observed using the following three approaches: conventional observation (CO); IC staining; and AA + IC staining. The primary endpoint was improved tumor visibility with increased ΔE using TXI with AA + IC.</p> Results <p>A total of 49 lesions were analyzed. The ΔE observed with TXI mode 1 (TXI-1) was significantly higher than that observed with other modes (median ΔE: 18.7 with CO, 42.8 with IC, and 51.6 with AA + IC; <i>p</i> &lt; 0.001). The highest ΔE was observed using TXI-1 with AA + IC (<i>p</i> &lt; 0.001). Location (upper/middle vs. lower side; <i>p</i> = 0.020) and gastrointestinal scope (H290Z vs. EZ-1500 vs. XZ-1200; <i>p</i> = 0.006) were associated with ΔEs observed using TXI-1 with AA + IC.</p> Conclusions <p>The highest color contrast between lesions and normal mucosa was observed using TXI-1 with AA + IC, indicating its potential to improve the visibility of gastric tumors.</p> Graphical Abstract <p></p>

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Utility of texture and color enhancement imaging combined with acetic acid–indigo carmine for improving visibility of gastric tumors: a single-center prospective study

  • 期刊论文

  • 发表日期：

    2026年5月26日

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  • Kazuhisa Yamaguchi,
  • Ai Fujimoto,
  • Nobuyuki Sato,
  • Yusuke Nishikawa,
  • Masashi Ono,
  • Takahiro Toba,
  • Takahisa Matsuda

摘要

Background

Texture and color enhancement imaging (TXI) is an image-enhanced endoscopy technique that facilitates gastric lesion visualization by enhancing color and texture. This study aimed to assess the tumor extent using a combination of acetic acid (AA) and indigo carmine (IC) staining (AA + IC staining) with TXI for gastric tumors.

Methods

Between March 2022 and February 2023, we prospectively enrolled 50 consecutive patients with gastric tumors treated with endoscopic resection at Toho University Omori Medical Center. We compared color differences (ΔEs) between neoplastic lesions and surrounding mucosa using white light imaging (WLI) and TXI (modes 1 and 2). Each lesion was observed using the following three approaches: conventional observation (CO); IC staining; and AA + IC staining. The primary endpoint was improved tumor visibility with increased ΔE using TXI with AA + IC.

Results

A total of 49 lesions were analyzed. The ΔE observed with TXI mode 1 (TXI-1) was significantly higher than that observed with other modes (median ΔE: 18.7 with CO, 42.8 with IC, and 51.6 with AA + IC; p < 0.001). The highest ΔE was observed using TXI-1 with AA + IC (p < 0.001). Location (upper/middle vs. lower side; p = 0.020) and gastrointestinal scope (H290Z vs. EZ-1500 vs. XZ-1200; p = 0.006) were associated with ΔEs observed using TXI-1 with AA + IC.

Conclusions

The highest color contrast between lesions and normal mucosa was observed using TXI-1 with AA + IC, indicating its potential to improve the visibility of gastric tumors.

Graphical Abstract