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Objectives The utility of texture and color enhancement imaging (TXI) in detecting gastric cancer (GC) has been investigated. However, few reports exist on TXI mode2 (TXI2) used for detecting GC; this study investigated the efficacy of TXI2 in GC detection during screening endoscopy. Methods This study enrolled 13,440 participants with confirmed Helicobacter pylori (H. pylori) infection status who underwent screening endoscopy by 20 endoscopists in our health screening center. The participants were divided into two groups: one group was observed using white light imaging (WLI) only by 17 endoscopists (WLI group, 10,745 participants), and the other group was observed using TXI2 only by the other three endoscopists (TXI2 group, 2695 participants). We analyzed the detection rate and the characteristics of GC. In addition, considering the bias due to the diagnostic ability, we analyzed the subset of the WLI group where the participants were evaluated by the top three endoscopists based on their GC detection rate (Expert‐WLI group, 2792 participants) for comparison with the TXI2 group. Results Fifty patients were diagnosed with GC. The GC detection rates were 0.68% and 0.71% in the Expert‐WLI and TXI2 groups, respectively. In patients who underwent screening endoscopy after H. pylori eradication, the detection rates of differentiated GC, L‐region lesions, and surface depressed‐type lesions were 0.52%, 0%, and 0.43% in the Expert‐WLI group and 1.36%, 0.78%, and 1.36% in the TXI2 group, respectively. Conclusions In screening endoscopy, the detectability of differentiated GC and L‐region lesions and surface depressed‐type lesions after H. pylori eradication was higher in TXI2.

Image‐enhanced endoscopy (IEE) has advanced gastrointestinal disease diagnosis and treatment. Traditional white‐light imaging has limitations in detecting all gastrointestinal diseases, prompting the development of IEE. In this review, we explore the utility of IEE, including texture and color enhancement imaging and red dichromatic imaging, in pancreatobiliary (PB) diseases. IEE includes methods such as chromoendoscopy, optical‐digital, and digital methods. Chromoendoscopy, using dyes such as indigo carmine, aids in delineating lesions and structures, including pancreato‐/cholangio‐jejunal anastomoses. Optical‐digital methods such as narrow‐band imaging enhance mucosal details and vessel patterns, aiding in ampullary tumor evaluation and peroral cholangioscopy. Moreover, red dichromatic imaging with its specific color allocation, improves the visibility of thick blood vessels in deeper tissues and enhances bleeding points with different colors and see‐through effects, proving beneficial in managing bleeding complications post‐endoscopic sphincterotomy. Color enhancement imaging, a novel digital method, enhances tissue texture, brightness, and color, improving visualization of PB structures, such as PB orifices, anastomotic sites, ampullary tumors, and intraductal PB lesions. Advancements in IEE hold substantial potential in improving the accuracy of PB disease diagnosis and treatment. These innovative techniques offer advantages paving the way for enhanced clinical management of PB diseases. Further research is warranted to establish their standard clinical utility and explore new frontiers in PB disease management.

Objectives We aimed to conduct a systematic review and meta‐analysis to assess the value of image‐enhanced endoscopy including blue laser imaging (BLI), linked color imaging, narrow‐band imaging (NBI), and texture and color enhancement imaging to detect and diagnose gastric cancer (GC) compared to that of white‐light imaging (WLI). Methods Studies meeting the inclusion criteria were identified through PubMed, Cochrane Library, and Japan Medical s Society databases searches. The pooled risk ratio for dichotomous variables was calculated using the random‐effects model to assess the GC detection between WLI and image‐enhanced endoscopy. A random‐effects model was used to calculate the overall diagnostic performance of WLI and magnifying image‐enhanced endoscopy for GC. Results Sixteen studies met the inclusion criteria. The detection rate of GC was significantly improved in linked color imaging compared with that in WLI (risk ratio, 2.20; 95% confidence interval [CI], 1.39–3.25; p < 0.01) with mild heterogeneity. Magnifying endoscopy with NBI (ME‐NBI) obtained a pooled sensitivity, specificity, and area under the summary receiver operating curve of 0.84 (95 % CI, 0.80–0.88), 0.96 (95 % CI, 0.94–0.97), and 0.92, respectively. Similarly, ME‐BLI showed a pooled sensitivity, specificity, and area under the curve of 0.81 (95 % CI, 0.77–0.85), 0.85 (95 % CI, 0.82–0.88), and 0.95, respectively. The diagnostic efficacy of ME‐NBI/BLI for GC was evidently high compared to that of WLI, However, significant heterogeneity among the NBI studies still existed. Conclusions Our meta‐analysis showed a high detection rate for linked color imaging and a high diagnostic performance of ME‐NBI/BLI for GC compared to that with WLI.

Objective To evaluate the visibility of colorectal lesions using a novel image processing algorithm, texture and color enhancement imaging (TXI), that allows the acquisition of brighter images with enhanced color and surface structure. Methods During August–September 2019, patients referred for endoscopic treatment were prospectively recruited. Electronic data acquired while observing colorectal lesions using white light imaging (WLI) were obtained and recorded: WLI, TXI mode1 (with color enhancement), and TXI mode2 (without color enhancement) videos were constructed. The lesions were also recorded using narrow‐band imaging (NBI) from the same perspective as WLI. Four video clips (WLI, TXI mode1, TXI mode2, and NBI) were made per lesion. Thereafter, video files for evaluations were prepared by randomly arranging all video clips. Finally, visualization scores were evaluated by four endoscopists, and the WLI, TXI mode1, TXI mode2, and NBI results were compared. Results Overall, 22 patients with 68 lesions were recruited; the video file for evaluation subsequently comprised 272 randomly arranged video clips. Mean visualization scores using WLI, TXI mode1, TXI mode2, and NBI were 70.0 (±20.1), 80.5 (±18.6), 75.6 (±18.1), and 69.0 (±20.6), respectively. Mean visualization scores for flat lesions using WLI, TXI mode1, TXI mode2, and NBI were 64.1 (±21.2), 76.5 (±20.18), 71.8 (±19.4), and 64.2 (±22.0), respectively. Visualization scores using TXI mode1 were significantly better than those using WLI, TXI mode2, or NBI. Conclusions TXI enables improved visualization of colorectal lesions, even flat lesions, than WLI and NBI. TXI may allow better detection of colorectal lesions, although further prospective studies are required.

Objectives Overlooking early gastric cancer (EGC) during endoscopy is an issue to be resolved. Image‐enhanced endoscopy is expected to improve EGC detection. This study investigated the usefulness of third‐generation narrow band imaging (3G‐NBI) and texture and color enhancement imaging (TXI) in improving the visibility of EGC using the color difference between EGC and its surrounding gastric mucosa. Methods In this retrospective observational study, we examined 51 superficial EGCs that underwent endoscopic submucosal dissection and were observed by all three methods: 3G‐NBI, TXI, and white light imaging (WLI). The primary endpoint was to compare the color difference of each method. For each EGC, we prepared one non‐magnifying image for each method so that the location and size of the lesion in each image were the same. The L*a*b* color space was used to evaluate the color values. When the color values of the cancerous lesion and its surrounding mucosa were (L*c, a*c, b*c) and (L*s, a*s, b*s), respectively, the color difference was defined to be [(L*c−L*s)2+(a*c−a*s)2+(b*c−b*s)2]1/2. Results The median color difference was 9.2 (interquartile range, 5.3–15.7) in WLI, 13.5 (interquartile range, 9.4–19.5) in 3G‐NBI, and 15.3 (interquartile range, 9.1–22.1) in TXI. Statistically, the color difference was significantly larger in 3G‐NBI than in WLI (p < 0.001) and TXI compared with WLI (p < 0.001). However, there was no significant difference between 3G‐NBI and TXI (p = 0.330). Conclusions Regarding color difference, both 3G‐NBI and TXI were estimated to be more useful than WLI in improving the visibility of superficial EGC.

Hereditary diffuse gastric cancer (HDGC) is an autosomal dominant cancer caused by CDH1 mutation. HDGC causes multiple signet ring cell carcinomas (SRCCs) throughout the stomach. Few reports exist on the endoscopic findings during screening endoscopy, leading to the diagnosis of HDGC in its early stages. Recently, a new image‐enhancement endoscopy technique, texture and color enhancement imaging (TXI), has been developed to improve the visibility of early gastric cancer. To the best of our knowledge, the use of TXI leading to HDGC diagnosis has not been reported. In this report, TXI contributed to the diagnosis of HDGC, and the patient was treated with total gastrectomy. A 27‐year‐old woman with a family history of gastric cancer underwent esophagogastroduodenoscopy, which revealed two pale lesions in the lower body of the stomach. Histological examination of the biopsy specimen revealed SRCC and the patient was referred to our hospital for treatment. Multiple lesions were found in the lower body using TXI, and a targeted biopsy confirmed other SRCCs. We suspected her disease to be HDGC, and the patient underwent a total gastrectomy. Histopathology showed multiple SRCCs (>60), but no lymph node metastases. Genetic testing revealed CDH1 mutations. The final pathological stage of the tumor was pT1a(m) N0M0 Stage I. TXI may be helpful in detecting multiple SRCCs in patients with HDGC. Endoscopists should be aware of HDGC, and careful investigation of the entire stomach is required for patients with diffuse‐type gastric cancer before treatment.

Background H. pylori infection has been recognized as a type 1 carcinogen of the gastric malignancy; therefore, early diagnosis and treatment are the corner stone of eradication. Recent findings have also shown that atrophy and intestinal metaplasia remain after successful eradication, which moderately increases the risk of gastric cancer compared with those who have never infected, so the evaluation of gastric mucosa during gastroscopy is important. Aims We aimed to describe and summarize the reliable literature and proposed features of H. pylori infection status and gastritis in research on newly developed endoscopic models that influence clinical practice. In the result, conventional white light endoscopic, image‐enhanced endoscopic models, and studies related to the Kyoto classification of gastritis were searched and reviewed. Results Kyoto classification of gastritis and modified Kyoto classification scoring model for gastritis using conventional white light image (CWLI) endoscopy is an effective tool for evaluating current H. pylori infection status, past infections, eradications, noninfections, and pre‐cancerous conditions. This model is widely used, low cost, and time‐efficient, and is supported by recent findings. Advanced image‐enhanced endoscopic models combined with magnifying endoscopy provide more clear endoscopic features for H. pylori infection status and early gastric cancer. Conclusion According to H pylori infection status, endoscopic prediction of gastric mucosal surface architecture analysis is possible, which influences clinical management. Endoscopic models might lead us to accurate and early diagnose of H. pylori infection status and may not be effective only for the eradication of H. pylori infection but also in the detection of early gastric cancer status. This study highlights the endoscopic appearance of gastric mucosa using various models, including Conventional White Light Imaging (CWLI), Image‐Enhanced Endoscopy (IEE), and the Kyoto classification system for gastritis. These models are effective in distinguishing H. pylori infection status, including current, eradicated, non‐infected, and pre‐cancerous conditions. The use of WLI technique, due to their global accessibility, low cost, and time efficiency, aids in accurate diagnosis and early detection of H. pylori‐related diseases and gastric cancer.

The Japan Gastroenterological Endoscopy Society (JGES) held four serial symposia between 2021 and 2022 on state‐of‐the‐art issues related to advanced diagnostic endoscopy of the upper gastrointestinal tract. This review summarizes the four core sessions and presents them as a conference report. Eleven studies were discussed in the 101st JGES Core Session, which addressed the challenges and prospects of upper gastroenterological endoscopy. Ten studies were also explored in the 102nd JGES Core Session on advanced upper gastrointestinal endoscopic diagnosis for decision‐making regarding therapeutic strategies. Moreover, eight studies were presented during the 103rd JGES Core Session on the development and evaluation of endoscopic artificial intelligence in the field of upper gastrointestinal endoscopy. Twelve studies were also discussed in the 104th JGES Core Session, which focused on the evidence and new developments related to the upper gastrointestinal tract. The endoscopic diagnosis of upper gastrointestinal diseases using image‐enhanced endoscopy and AI is one of the most recent topics and has received considerable attention. These four core sessions enabled us to grasp the current state‐of‐the‐art in upper gastrointestinal endoscopic diagnostics and identify future challenges. Based on these studies, we hope that an endoscopic diagnostic system useful in clinical practice is established for each field of upper gastrointestinal endoscopy.

Owing to its high mortality rate, the prevention of colorectal cancer is of particular importance. The resection of colorectal polyps is reported to drastically reduce colorectal cancer mortality, and examination by endoscopists who had a high adenoma detection rate was found to lower the risk of colorectal cancer, highlighting the importance of identifying lesions. Various devices, imaging techniques, and diagnostic tools aimed at reducing the rate of missed lesions have therefore been developed to improve detection. The distal attachments and devices for improving the endoscopic view angle are intended to help avoid missing blind spots such as folds and flexures in the colon, whereas the imaging techniques represented by image‐enhanced endoscopy contribute to improving lesion visibility. Recent advances in artificial intelligence‐supported detection systems are expected to supplement an endoscopist's eye through the instant diagnosis of the lesions displayed on the monitor. In this review, we provide an outline of each tool and assess its impact on the reduction in the incidence of missed colorectal polyps by summarizing previous clinical research and meta‐analyses. Although useful, the many devices, image‐enhanced endoscopy, and artificial intelligence tools exhibited various limitations. Integrating these tools can improve their shortcomings. Combining artificial intelligence‐based diagnoses with wide‐angle image‐enhanced endoscopy may be particularly useful. Thus, we hope that such tools will be available in the near future.

Several endoscopic findings obtained by magnifying image-enhanced endoscopy (IEE) are reportedly correlated with gastric intestinal metaplasia (IM); however, the differences between magnifying and nonmagnifying IEE for the diagnosis of gastric IM remain unknown. This study included 100 consecutive patients who underwent narrow-band imaging endoscopy. Four areas of the stomach were evaluated using nonmagnifying and magnifying IEE. Light-blue crest (LBC), white opaque substance (WOS), and endoscopic grading of the gastric IM (EGGIM) were assessed. The concordance rates between nonmagnifying and magnifying IEE were 80.5% for LBC and 93.3% for WOS. The strength of agreement between each observation technique showed good reproducibility, with a kappa value of 0.69 and 0.83 for LBC and WOS, respectively. The individual EGGIM score indicated a good correlation between nonmagnifying and magnifying IEE (concordance rate, 75%; kappa value, 0.67). The prevalence of a high EGGIM score in patients with and without gastric cancer (GC) showed a significant difference both with nonmagnifying IEE (odds ratio (OR), 3.3; 95% confidence interval (CI), 1.2–9.0), and magnifying IEE (OR, 3.1; 95% CI, 1.1–8.9). Nonmagnifying IEE has the potential to stratify the individual risk of GC, similar to magnifying IEE, warranting further investigation with histological assessment.