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

## TL;DR

This study evaluates a new imaging technique called TXI to improve the visibility of gastritis features during endoscopy, aiding in the detection of H. pylori infection and cancer risk.

## Contribution

The study introduces and validates texture and color enhancement imaging (TXI) as a novel endoscopic tool for gastritis assessment.

## Key findings

- TXI-1 significantly improves visibility of gastritis features like redness and venous patterns compared to standard imaging.
- Objective color analysis confirms TXI-1 provides greater color differentiation for map-like redness.
- TXI-1 shows moderate to substantial inter-rater reliability among endoscopists.

## Abstract

The Kyoto Classification of Gastritis enables endoscopic assessment of Helicobacter pylori (H. pylori) infection status and gastric cancer risk. Initially developed for image‐enhanced endoscopy, texture and color enhancement imaging (TXI) allows us to easily distinguish differences in mucosal structure and color. The aim of this study was to evaluate the use of TXI in the visibility of endoscopic findings of gastritis.

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.

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.

TXI‐1 enhances the visibility of key endoscopic features of H. pylori–associated gastritis. TXI‐1 may serve as a useful tool for endoscopic assessment of H. pylori–associated gastritis.

The study protocol was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000045323).

Statistically significant differences between the three groups were observed. Furthermore, the ΔE* of texture and color enhancement imaging (TXI)‐1 was significantly greater than that of TXI‐2. Box plots show the median (center line) and interquartile range (box). Whiskers extend to the most extreme values within 1.5×IQR, and values beyond the whiskers are plotted as outliers. * p < 0.001.