Usefulness of texture and color enhancement imaging (TXI) in early gastric cancer found after Helicobacter pylori eradication

Q: What diagnostic challenge does the study focus on after Helicobacter pylori eradication?

Early-stage gastric cancer lesions after Helicobacter pylori eradication are often hard to detect and diagnose using conventional white light endoscopy.

Q: How does TXI differ from white light endoscopy in this study?

TXI enhances endoscopic visualization by optimizing structure, color, and brightness via texture and color processing, evaluated here in TXI mode 1 (TXI1) and mode 2 (TXI2) against WL.

Q: What outcomes were compared to determine whether TXI is useful?

The study compared visibility scores, color differences (ΔE), diagnostic accuracy, and lesion detection time between WL and TXI (TXI1/TXI2) in both expert endoscopists and trainee endoscopists.

Sep 28, 2026

Uploaded by Oliver

Early-stage gastric cancer lesions found after Helicobacter pylori eradication are often difficult to diagnose with conventional white light endoscopy. This study evaluated whether Texture and Color Enhancement Imaging (TXI) improves lesion visibility and diagnostic performance after successful eradication, compared with white light (WL) using endoscopic images in WLI, TXI1, and TXI2. Visibility, color difference (ΔE), diagnostic accuracy, and lesion detection time were analyzed in experts and trainee endoscopists. TXI1 showed higher diagnostic accuracy and shorter detection time, supporting improved correct diagnosis.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Materials and methods

Patients

Endoscopic procedure

[www. nature.com/scientificreports](www. nature.com/scientificreports) OPEN Usefulness of texture and color enhancement imaging (TXI) in early gastric cancer found after Helicobacter pylori eradication Takuya Shijimaya, Tomomitsu Tahara*, Tomio Uragami, NarumiYano, Yutaro Tokutomi, Atsushi Uwamori, Shuhei Nishimon, Sanshiro Kobayashi, Yasushi Matsumoto, Naohiro Nakamura, Takashi Okazaki, Yu Takahashi, Takashi Tomiyama, Yusuke Honzawa, Norimasa Fukata, Toshiro Fukui & Makoto Naganuma Early-stage gastric cancer (EGC) found after Helicobacter pylori (Hp) eradication is often difficult to diagnose using conventional white light (WL) endoscopy. We aimed to evaluate whether Texture and Color Enhancement Imaging (TXI), a new image-enhanced endoscopy enhances the EGC lesions after Hp eradication. We also compared diagnostic accuracy and lesion detection time between WLand TXI in trainee endoscopists. 58 EGC lesions after successful Hp eradication were enrolled. Using endoscopic images in WLI, TXI mode 1 (TXI1), and TXI mode 2 (TXI2), visibility of EGC was assessed by six expert endoscopists using a subjective score. Mean color differences (ΔE) of four matched adjacent and intra-tumoral points were examined. Using randomly allocated images, diagnostic accuracy and lesion detection time were evaluated in three trainee endoscopists. Visibility score was unchanged (Score 0) in 20.7%(12/58) and 45.6%(26/57), slightly improved (Score 1) in 60.3%(35/58) and 52.6%(30/57), obviously improved (Score 2) in 45.6%(26/58) and 1.8%(1/57), inTXI1 and TXI2 compared to WL, respectively. Mean ΔE ± SEM inTXI1 (22.90 ± 0.96), and TXI2 (15.32 ± 0.71) were higher than that in WL (1.88 ± 0.26, both P < 0.0001). TXI1 presented higher diagnostic accuracy compared toWL, in two of three trainees (94.8% vs. 74.1%, 100% vs. 89.7%, P = 0.003; < 0.005, respectively) . Lesion detection time was shorter inTXI1 in two of three trainees (P = 0.006, 0.004, respectively) compared toWL. TXI improves visibility of EGC after Hp eradication that may contribute to correct diagnosis. Gastric cancer is one of the most common malignancies and the third causal of cancer death worldwide 1. Although patients who have advanced stage gastric cancer have a poor prognosis, the 5-year disease-specific survival rate for patients with early gastric cancer (EGC) reaches about 90%2. Therefore, early detection is important to improve the prognosis of gastric cancer. Endoscopy is a main tool to diagnose gastric cancer and have been widely used in the gastric cancer screening in countries with high incidence of gastric cancer such as Japan and Korea3,4. However, detectability of EGC may be affected by the endoscopist’s ability and lesion characteristics, associated with diagnosis difficult, for example, EGC found after Helicobacter pylori (Hp) eradication5. Eradication therapy against Hp infection, which is defined as an obvious carcinogen6, has been recommended for the prevention of gastric cancer. However, gastric cancer sometimes occurs even after successful Hp eradication7,8, and it is often difficult to detect and diagnose EGC after Hp eradication correctly using conventional white light endoscopy5. It has been reported that EGC found after Hp eradication appears as indistinct forms such as tiny and flattened lesions5,7,8. Usefulness of image-enhanced endoscopy for the detection of EGC after Hp eradication is recently suggested9, 10. Texture and color enhancement imaging (TXI) is a new generation IEE system that is a white light image (WLI)-based imaged enhanced endoscopy11. In TXI, an image initially obtained by white-light irradiation is divided into texture and base images. Divided images are recombined after enhancing the texture and correcting Third Department of Internal Medicine, Kansai Medical University, 2-5-1 Shin-Machi, Hirakata, Osaka 573-1010, Japan.*[email: taharatm@takii.kmu.ac.jp](email: taharatm@takii.kmu.ac.jp) [www. nature.com/scientificreports/](ww

FAQs

What diagnostic challenge does the study focus on after Helicobacter pylori eradication?

Early-stage gastric cancer lesions after Helicobacter pylori eradication are often hard to detect and diagnose using conventional white light endoscopy.

How does TXI differ from white light endoscopy in this study?

TXI enhances endoscopic visualization by optimizing structure, color, and brightness via texture and color processing, evaluated here in TXI mode 1 (TXI1) and mode 2 (TXI2) against WL.

What outcomes were compared to determine whether TXI is useful?

The study compared visibility scores, color differences (ΔE), diagnostic accuracy, and lesion detection time between WL and TXI (TXI1/TXI2) in both expert endoscopists and trainee endoscopists.

Sep 28, 2026

Uploaded by Oliver