Uchida Ryota, Ueyama Hiroya, Takeda Tsutomu, Nakamura Shunsuke, Uemura Yasuko, Iwano Tomoyo, Yamamoto Momoko, Utsunomiya Hisanori, Abe Daiki, Oki Shotaro, Suzuki Nobuyuki, Ikeda Atsushi, Akazawa Yoichi, Ueda Kumiko, Hojo Mariko, Nojiri Shuko, Yao Takashi, Nagahara Akihito
Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan.
Medical Technology Innovation Center Juntendo University School of Medicine Tokyo Japan.
DEN Open. 2025 May 22;6(1):e70147. doi: 10.1002/deo2.70147. eCollection 2026 Apr.
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.
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 color values and the color difference (Δ*) in the CIE LAB color space system.
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 ( < 0.01). The inter-rater reliability for TXI-1 and TXI-2 was "excellent" for all endoscopists. The use of Δ* revealed statistically significant differences between WLI and TXI-1 ( < 0.01).
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.
“灰色征”（GCS）是胃底腺息肉与质子泵抑制剂相关的一种新的内镜特征（PPI - FGP）。在此，我们比较纹理和颜色增强成像（TXI）与白光成像（WLI）在检测GCS方面的能力。
在这项前瞻性研究中，2021年4月至2022年10月期间，我院连续纳入了19例PPI - FGP患者。由10位内镜医师收集并比较使用WLI、TXI模式1（TXI - 1）、TXI模式2（TXI - 2）和窄带成像（NBI）的PPI - FGP内镜图像。每种模式（图像增强内镜）下GCS的可见度评分如下：5分，改善；4分，有所改善；3分，相当；2分，有所降低；1分，降低。还评估了评分者间的可靠性（组内相关系数，ICC）。基于CIE LAB颜色空间系统中的颜色值和颜色差异（Δ*）对图像进行客观评估。
所有内镜医师中，与WLI相比，TXI - 1使GCS可见度提高的比例为82.6%，TXI - 2为86.9%，NBI为0%。所有内镜医师的总可见度得分分别为：TXI - 1为44.9分；TXI - 2为42.9分；NBI为17.4分。与NBI相比，使用TXI - 1和TXI - 2时可见度得分显著更高（<0.01）。所有内镜医师对TXI - 1和TXI - 2的评分者间可靠性均为“优秀”。使用Δ*显示WLI与TXI - 1之间存在统计学显著差异（<0.01）。
对于GCS的可视化，TXI比WLI有所改进，实习内镜医师和专家内镜医师均可使用，且效率和准确性相同。
