Visibility Evaluation of Fundic Gland Polyp Associated With Proton Pump Inhibitor in Texture and Color Enhancement Imaging

Objectives

A ‘gray color sign’ (GCS) is a new endoscopic feature of fundic gland polyp associated with proton pump inhibitor (PPI-FGP). Here, we compare the ability of texture and color enhancement imaging (TXI) to white light imaging (WLI) with regard to the detection of GCS.

Methods

In this prospective study, 19 consecutive patients with PPI-FGP were enrolled at our hospital from April 2021 to October 2022. Endoscopic images of PPI-FGP using WLI, TXI mode1 (TXI-1), TXI mode2 (TXI-2), and narrow-band imaging (NBI) were collected and compared by 10 endoscopists. Visibility of GCS by each mode (Image enhancement endoscopy) was scored as follows: 5, improved; 4, somewhat improved; 3, equivalent; 2, somewhat decreased; and 1, decreased. The inter-rater reliability (intra-class correlation coefficient, ICC) was also evaluated. The images were objectively evaluated based on L* a* b* color values and the color difference (ΔE*) in the CIE LAB color space system.

Results

Improved visibility of GCS compared with WLI was achieved for: TXI-1: 82.6%, TXI-2: 86.9%, and NBI: 0% for all endoscopists. Total visibility scores were: TXI-1, 44.9; TXI-2, 42.9; NBI, 17.4 for all endoscopists. Visibility scores were significantly higher using TXI-1 and TXI-2 compared with NBI (p < 0.01). The inter-rater reliability for TXI-1 and TXI-2 was “excellent” for all endoscopists. The use of ΔE* revealed statistically significant differences between WLI and TXI-1 (p < 0.01).

Conclusions

TXI is an improvement over WLI for the visualization of GCS, and can be used by both trainee and expert endoscopists with equal efficiency and accuracy.