P3337 - Visibility evaluation of Gastric Epithelial Neoplasm of Fundic Gland Mucosa Lineage in a New Image Enhanced Endoscopy; Texture and Color Enhancement Imaging

Momoko Yamamoto, MD¹, Hisanori Utsunomiya, MD², Hiroya Ueyama, MD, PhD¹, Tsutomu Takeda, MD, PhD², Shunsuke Nakamura, MD², Yasuko Uemura, MD², Tomoyo Iwano, MD², Ryota Uchida, MD², Kentaro Ito, MD³, Daiki Abe, MD, PhD², Shotaro Oki, MD, PhD², Nobuyuki Suzuki, MD, PhD², Atsusi Ikeda, MD, PhD², Yoichi Akazawa, MD, PhD², Hirofumi Fukushima, MD, PhD³, Kumiko Ueda, MD, PhD², Mariko Hojo, MD, PhD³, Takashi Yao, MD, PhD⁴, Shuko Nojiri, PhD², Akihito Nagahara, MD, PhD^3
1Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan; ²Juntendo University School of Medicine, Bunkyoku, Tokyo, Japan; ³Juntendo University Hospital, Bunkyo-ku, Tokyo, Japan; ⁴Juntendo University, Graduate School of Medicine, Bunkyoku, Tokyo, Japan

Introduction: Recently, Helicobacter pylori-uninfected gastric cancer (HPUGC), such as a gastric epithelial neoplasm of fundic gland mucosa lineage (GEN-FGML) is relatively increasing in Japan due to the wide spread of eradication therapy. Since the detection and endoscopic diagnosis of GEN-FGML is considered to be difficult, an effective observation method in screening endoscopy is required. In this context, a new image enhancement endoscopy (IEE), Texture and Color Enhancement Imaging (TXI; OLYMPUS) was developed in 2020. This IEE allows the easy recognition of differences in mucosal color and structure and makes it easier to recognize structural changes and slight color changes in the image and supports the detection of lesions. We aimed to investigate whether the visibility of GEN-FGML improved in TXI compared with white light imaging (WLI).

Methods: In this single-center prospective clinical study, 50 GEN-FGML lesions in 35 patients between October 2020 and June 2023 at our hospital were enrolled. Endoscopic images of GEN-FGML using WLI, TXI mode 1 (TXI-1), TXI mode 2 (TXI-2), and narrow-band imaging (NBI) were compared by 5 experts and 5trainees. Endoscopists assessed visibility as follows: 5 (improved), 4 (somewhat improved), 3 (equivalent), 2 (somewhat decreased), and 1 (decreased). We analyzed the visibility score, objective evaluation based on L* a* b* color values in the CIE LAB color space system, and the inter-rater reliability (intra-class correlation coefficient [ICC]).

Results: The histopathological type of GEN-FGML was classified into gastric adenocarcinoma of fundic-gland type (n=45) and gastric adenocarcinoma of fundic-gland mucosa type (n=5). Total visibility scores of overall lesions were TXI-1: 44.0, TXI-2: 40.0, NBI: 31.0 for all endoscopists; TXI-1: 21.0, TXI-2: 18.5, NBI: 15.0 for experts; and TXI-1: 23.0, TXI-2: 21.0, NBI: 14.5 for trainees. In total scores for all endoscopists, TXI-1 and TXI-2 improved visibility compared to WLI, and TXI-1 was significantly higher than TXI-2 (p < 0.01). The ΔE* of TXI was significantly higher than WLI (p < 0.01). ICC for TXI-1 and TXI-2 was “almost perfect” and “substantial” for all endoscopists.

Discussion: TXI, especially TXI-1, may improve the endoscopic detection of GEN-FGML compared with WLI, regardless of the endoscopist’s skill.


Disclosures:


Momoko Yamamoto, MD¹, Hisanori Utsunomiya, MD², Hiroya Ueyama, MD, PhD¹, Tsutomu Takeda, MD, PhD², Shunsuke Nakamura, MD², Yasuko Uemura, MD², Tomoyo Iwano, MD², Ryota Uchida, MD², Kentaro Ito, MD³, Daiki Abe, MD, PhD², Shotaro Oki, MD, PhD², Nobuyuki Suzuki, MD, PhD², Atsusi Ikeda, MD, PhD², Yoichi Akazawa, MD, PhD², Hirofumi Fukushima, MD, PhD³, Kumiko Ueda, MD, PhD², Mariko Hojo, MD, PhD³, Takashi Yao, MD, PhD⁴, Shuko Nojiri, PhD², Akihito Nagahara, MD, PhD³. P3337 - Visibility evaluation of Gastric Epithelial Neoplasm of Fundic Gland Mucosa Lineage in a New Image Enhanced Endoscopy; Texture and Color Enhancement Imaging, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.