Utility of texture and color enhancement imaging combined with acetic acid-indigo carmine for improving visibility of gastric tumors: a single-center prospective study.

Kazuhisa Yamaguchi, Ai Fujimoto, Nobuyuki Sato, Yusuke Nishikawa, Masashi Ono, Takahiro Toba, Takahisa Matsuda

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Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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7 authors.

Kazuhisa YamaguchiDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, 6-11-1 Omori Nishi, Ota-Ku, Tokyo, 143-8541, Japan. kazuhisa.yamaguchi@med.toho-u.ac.jp.ORCID http://orcid.org/0000-0003-0494-9427

Ai FujimotoDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, 6-11-1 Omori Nishi, Ota-Ku, Tokyo, 143-8541, Japan.

Nobuyuki SatoDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, 6-11-1 Omori Nishi, Ota-Ku, Tokyo, 143-8541, Japan.

Yusuke NishikawaDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, 6-11-1 Omori Nishi, Ota-Ku, Tokyo, 143-8541, Japan.

Masashi OnoDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, 6-11-1 Omori Nishi, Ota-Ku, Tokyo, 143-8541, Japan.

Takahiro TobaDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, 6-11-1 Omori Nishi, Ota-Ku, Tokyo, 143-8541, Japan.

Takahisa MatsudaDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, 6-11-1 Omori Nishi, Ota-Ku, Tokyo, 143-8541, Japan.

Funding

the Japan Society for the Promotion of Endoscopy No.22-036

6 · The paper itself

Abstract

backgroundTexture and color enhancement imaging (TXI) is an image-enhanced endoscopy technique that facilitates gastric lesion visualization by enhancing color and texture. This study aimed to assess the tumor extent using a combination of acetic acid (AA) and indigo carmine (IC) staining (AA + IC staining) with TXI for gastric tumors.

methodsBetween March 2022 and February 2023, we prospectively enrolled 50 consecutive patients with gastric tumors treated with endoscopic resection at Toho University Omori Medical Center. We compared color differences (ΔEs) between neoplastic lesions and surrounding mucosa using white light imaging (WLI) and TXI (modes 1 and 2). Each lesion was observed using the following three approaches: conventional observation (CO); IC staining; and AA + IC staining. The primary endpoint was improved tumor visibility with increased ΔE using TXI with AA + IC.

resultsA total of 49 lesions were analyzed. The ΔE observed with TXI mode 1 (TXI-1) was significantly higher than that observed with other modes (median ΔE: 18.7 with CO, 42.8 with IC, and 51.6 with AA + IC; p < 0.001). The highest ΔE was observed using TXI-1 with AA + IC (p < 0.001). Location (upper/middle vs. lower side; p = 0.020) and gastrointestinal scope (H290Z vs. EZ-1500 vs. XZ-1200; p = 0.006) were associated with ΔEs observed using TXI-1 with AA + IC.

conclusionsThe highest color contrast between lesions and normal mucosa was observed using TXI-1 with AA + IC, indicating its potential to improve the visibility of gastric tumors.

Indexed as

Acetic AcidColoring AgentsGastroscopyImage EnhancementIndigo CarmineStomach NeoplasmsAgedAged, 80 and overFemaleHumansMaleMiddle AgedProspective StudiesAcetic AcidColoring AgentsIndigo CarmineAcetic acidEarly gastric cancerEndoscopyTexture and color enhancement imagingWhite light imaging

Identifiers

PMID42191959

DOI10.1007/s00464-026-12913-3

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.