Texture and Color Enhancement Imaging for the Kyoto Classification of Gastritis: Evaluation of Visibility and Color Differences.

Introduction: The Kyoto Classification of Gastritis enables endoscopic assessment of Methods: This was a retrospective analysis using prospectively collected endoscopic data from a prospective, single-center study, in which 220 patients undergoing esophagogastroduodenoscopy were enrolled. Endoscopic images were obtained using both white light imaging (WLI) and TXI (TXI-1 and TXI-2). Ten endoscopists (five experts and five trainees) independently evaluated 52 matched image sets, scoring visibility on a 5-point scale. Inter-rater reliability was assessed using intraclass correlation coefficients. Objective color analysis using the CIE L*a*b* color space and ΔE* values was also performed for map-like redness. Results: TXI-1 improved visibility for diffuse redness, spotty redness, map-like redness, patchy redness, atrophic border, red streak, and the regular arrangement of collecting venules. Visibility of intestinal metaplasia was also enhanced by TXI-1, although to a lesser extent than other findings. TXI-1 demonstrated "moderate" to "substantial" inter-rater reliability. Objective colorimetric analysis confirmed significantly greater ΔE* values with TXI-1 versus WLI for map-like redness. Conclusion: TXI-1 enhances the visibility of key endoscopic features of Trial Registration: The study protocol was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000045323).